Handwerger S, Horowitz H, Coburn K, Kolokathis A, Wormser G P
Division of Infectious Diseases, Beth Israel Medical Center, Mount Sinai School of Medicine, New York, New York.
Rev Infect Dis. 1990 Jul-Aug;12(4):602-10. doi: 10.1093/clinids/12.4.602.
Leuconostocs, members of the family Streptococcacae, have only recently been recognized as potential pathogens. We describe six cases of leuconostoc bacteremia and review 11 additional cases of infection reported in the literature. Fifteen patients with bacteremia ranged from neonates to persons aged 78 years. Almost all were hospitalized with significant underlying diseases, had received previous antibiotic therapy, and had undergone procedures that interrupted the normal integumentary defense. Leuconostoc bacteremia was associated with fever, leukocytosis, and gastrointestinal complaints. Eight of 15 patients had polymicrobial bacteremia, seven of these eight with staphylococcal species. Clinical isolates of Leuconostoc were frequently misidentified, usually as viridans streptococci. All clinical isolates identified to date--and most agricultural isolates--demonstrate a high level of resistance to vancomycin. Successful regimens for treatment of Leuconostoc include high-dose penicillin, clindamycin, and where appropriate, removal of infected intravascular catheters. Susceptibility testing of all gram-positive bacteria isolated from normally sterile body sites is recommended.
明串珠菌属是链球菌科的成员，直到最近才被认为是潜在的病原体。我们描述了6例明串珠菌血症病例，并回顾了文献中另外报道的11例感染病例。15例菌血症患者年龄从新生儿到78岁不等。几乎所有患者都因严重的基础疾病住院，曾接受过抗生素治疗，并且接受过破坏正常皮肤防御功能的操作。明串珠菌血症与发热、白细胞增多和胃肠道症状有关。15例患者中有8例为多微生物菌血症，这8例中的7例伴有葡萄球菌属细菌。明串珠菌的临床分离株经常被误鉴定，通常被鉴定为草绿色链球菌。迄今为止鉴定出的所有临床分离株以及大多数农业分离株都对万古霉素表现出高度耐药性。治疗明串珠菌的成功方案包括大剂量青霉素、克林霉素，以及在适当情况下移除感染的血管内导管。建议对从通常无菌的身体部位分离出的所有革兰氏阳性菌进行药敏试验。
