Kunz Anjali N, Riera Diana, Hickey Patrick
Walter Reed Army Medical Center, Department of Pediatrics MCHL-K 6900 Georgia Avenue, NW Washington DC 20307, USA.
Anaerobe. 2009 Oct;15(5):195-6. doi: 10.1016/j.anaerobe.2009.03.003. Epub 2009 Mar 24.
Bacteremia is an uncommon complication after polypectomy and colonoscopy. We report one of the first cases of Clostridium perfringens bacteremia after polypectomy. Our patient was a four years old boy with congenital polyposis, who underwent colonoscopy and polypectomy without complication. Approximately 12h later he developed a fever and tachycardia with no other clinical symptoms. His blood cultures grew out penicillin susceptible C. perfringens and Enterococcus faecalis. He responded to antibiotic therapy and remained clinically asymptomatic for the duration of his course. There are a few reports of bacteremia after routine polypectomy, but no reported cases of C. perfringens bacteremia in the pediatric population. Clostridial sp. bacteremia can be fatal with devastating consequences if appropriate antibiotics and/or surgical debridement are delayed. Polymicrobial infection, as illustrated in our patient, is also common and can be a poor prognostic risk factor. Therefore, for patients with a history of polypectomy and new onset fever, anaerobic infections should be considered and empiric antibiotic therapy should include coverage for these organisms.
菌血症是息肉切除术后和结肠镜检查后一种不常见的并发症。我们报告了首例息肉切除术后产气荚膜梭菌菌血症病例。我们的患者是一名患有先天性息肉病的4岁男孩,他接受了结肠镜检查和息肉切除术,未出现并发症。大约12小时后,他出现发热和心动过速,无其他临床症状。他的血培养结果显示对青霉素敏感的产气荚膜梭菌和粪肠球菌生长。他对抗生素治疗有反应,在病程中一直没有临床症状。关于常规息肉切除术后菌血症的报道较少,但儿科人群中尚无产气荚膜梭菌菌血症的报道病例。如果延迟使用适当的抗生素和/或手术清创,梭菌属菌血症可能会致命,后果严重。如我们患者所示,多微生物感染也很常见,可能是一个预后不良的危险因素。因此,对于有息肉切除病史且新出现发热的患者,应考虑厌氧菌感染,经验性抗生素治疗应包括覆盖这些微生物。