一名急性髓系白血病患者因耐碳青霉烯类蜡样芽孢杆菌引发致命性肺炎。

A patient with acute myeloid leukemia who developed fatal pneumonia caused by carbapenem-resistant Bacillus cereus.

作者信息

Katsuya Hiroo, Takata Tohru, Ishikawa Takahiko, Sasaki Hidenori, Ishitsuka Kenji, Takamatsu Yasushi, Tamura Kazuo

机构信息

The Department of Medicine, Division of Medical Oncology, Infectious Disease, and Endocrinology, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.

出版信息

J Infect Chemother. 2009 Feb;15(1):39-41. doi: 10.1007/s10156-008-0654-8. Epub 2009 Mar 12.

DOI:10.1007/s10156-008-0654-8

PMID:19280299

Abstract

Bacillus cereus is known as a serious bacterial pathogen in neutropenic patients. B. cereus is often resistant to beta-lactams, including penicillins and cephalosporins. We report a case of fatal pneumonia caused by B. cereus in a patient with newly diagnosed acute myeloid leukemia (AML) during remission induction therapy. Cefepime was started for febrile neutropenia (FN) initially and was switched to panipem/betamipron, when fulminant pneumonia supervened. The isolated strain was resistant not only to cefepime but also to panipenem/betamipron. This is the first report of fulminant infection caused by carbapenem-resistant B. cereus in a neutropenic patient. B. cereus should be kept in mind as a target of empirical treatment when neutropenic patients develop pneumonia.

摘要

蜡样芽孢杆菌是中性粒细胞减少患者中一种严重的细菌病原体。蜡样芽孢杆菌通常对包括青霉素和头孢菌素在内的β-内酰胺类抗生素耐药。我们报告了1例新诊断的急性髓系白血病（AML）患者在缓解诱导治疗期间由蜡样芽孢杆菌引起的致命性肺炎病例。最初因发热性中性粒细胞减少（FN）开始使用头孢吡肟，当暴发性肺炎出现时改用帕尼培南/倍他米隆。分离出的菌株不仅对头孢吡肟耐药，而且对帕尼培南/倍他米隆耐药。这是中性粒细胞减少患者中由耐碳青霉烯类蜡样芽孢杆菌引起暴发性感染的首例报告。当中性粒细胞减少患者发生肺炎时，应将蜡样芽孢杆菌作为经验性治疗的目标加以考虑。