Taşbakan Mehmet Sezai, Yamazhan Tansu, Aydemir Söhret, Bacakoğlu Feza
Ege Universitesi Tip Fakültesi, GöGüs Hastaliklari Anabilim Dali, Izmir.
Mikrobiyol Bul. 2010 Jan;44(1):127-31.
Cupriavidus pauculus (formerly CDC Group IVc-2) is a non-fermentative, motile, gram-negative bacillus, rarely associated with human infections. It has been isolated from water, water from ultrafiltration systems and bottled mineral water. To date, 19 cases of bacteremia, two cases of peritonitis and one case of tenosynovitis associated with C. pauculus have been reported in English literature. In this paper, we report the first case of C. pauculus ventilator-associated pneumonia (VAP) in Turkey. A 47 years-old female with breast cancer was performed total mastectomy six years ago and received six cures of chemotherapy after surgery. The patient was hospitalized in medical oncology clinic with complaints of weight loss, nausea and vomiting for one year. Since she had problems of consiousness, dysphagia and pitosis, lumbar puncture was performed to rule out central nervous system infection or metastasis. Cryptococcal meningitis was diagnosed upon the examination of Indian-ink stained smear of cerebrospinal fluid and amphotericin B was initiated. On the 11th day of her follow up, she developed respiratory distress and was transferred to pulmonary intensive care and underwent invasive mechanical ventilator (IMV) therapy. On the 4th day of IMV; a new infiltration was detected on the upper zone of chest X-ray in addition to fever (38.3 degrees C) and intense endotracheal secretion. Therefore, bronchoscopic examination was performed and bronchoalveolar lavage and bronchoscope aspiration materials were obtained and cultivated. Bacteria grown at blood agar and EMB agar after 48 hours of incubation were stained as gram-negative bacilli and identified as C. pauculus by VITEK 2 compact system (bioMérieux Inc, USA). The strain was susceptible to ceftazidime, ciprofloxacin, imipenem, trimethoprim-sulfamethoxazole, piperacilin/tazobactam and resistant to amikacin. The case was considered as C. pauculus VAP and imipenem (500 mg, 4 x 1) for 14 days was initiated. Clinical and microbiological resolution was achieved by imipenem therapy. In conclusion, rare pathogens like C. pauculus should be considered among the possible causative agents in infections that develop in immunocompromised host.
浅黄贪铜菌（以前称为CDC IVc-2组）是一种非发酵、运动性、革兰氏阴性杆菌，很少与人类感染相关。它已从水、超滤系统的水和瓶装矿泉水中分离出来。迄今为止，英文文献中已报道了19例与浅黄贪铜菌相关的菌血症、2例腹膜炎和1例腱鞘炎。在本文中，我们报告了土耳其首例浅黄贪铜菌呼吸机相关性肺炎（VAP）病例。一名47岁的乳腺癌女性6年前接受了全乳房切除术，术后接受了6次化疗。患者因体重减轻、恶心和呕吐症状在肿瘤内科住院1年。由于她存在意识障碍、吞咽困难和上睑下垂问题，进行了腰椎穿刺以排除中枢神经系统感染或转移。脑脊液墨汁染色涂片检查诊断为隐球菌性脑膜炎，并开始使用两性霉素B治疗。在随访的第11天，她出现呼吸窘迫，被转入肺重症监护病房并接受有创机械通气（IMV）治疗。在IMV治疗的第4天；除发热（38.3摄氏度）和大量气管内分泌物外，胸部X线片上叶区域发现新的浸润影。因此，进行了支气管镜检查，并获取了支气管肺泡灌洗和支气管镜吸出物并进行培养。孵育48小时后在血琼脂和伊红美蓝琼脂上生长的细菌被染色为革兰氏阴性杆菌，并通过VITEK 2 compact系统（美国bioMérieux公司）鉴定为浅黄贪铜菌。该菌株对头孢他啶、环丙沙星、亚胺培南、复方新诺明、哌拉西林/他唑巴坦敏感，对阿米卡星耐药。该病例被认为是浅黄贪铜菌VAP，并开始使用亚胺培南（500毫克，每日4次）治疗14天。亚胺培南治疗实现了临床和微生物学缓解。总之，在免疫功能低下宿主发生的感染中，应将浅黄贪铜菌等罕见病原体视为可能的病原体之一。
