Uchino Yoshihito, Iriyama Noriyoshi, Matsumoto Ken, Hirabayashi Yukio, Miura Katsuhiro, Kurita Daisuke, Kobayashi Yujin, Yagi Mai, Kodaira Hitomi, Hojo Atsuko, Kobayashi Sumiko, Hatta Yoshihiro, Takeuchi Jin
Department of Hematology and Rheumatology, Nihon University School of Medicine, Itabashi Hospital, Japan.
Intern Med. 2012;51(19):2733-8. doi: 10.2169/internalmedicine.51.7258. Epub 2012 Oct 1.
Bacillus cereus (B. cereus) septicemia is a cause of life-threatening infection in patients with hematologic diseases. However, preventing a fatal prognosis in patients with B. cereus infection has not yet been achieved due to insufficient clinical investigations. To discover more optimal treatment strategies, we analyzed B. cereus septicemia in patients with hematologic diseases.
At our institution, we observed 13 cases of B. cereus septicemia in 12 patients with hematologic diseases between January 2001 and September 2010. The susceptibility of B. cereus strains to antibiotics was also analyzed.
Of 12 patients, four died of B. cereus septicemia. In this study, the delayed administration of appropriate antibiotics (starting >24 hours after presentation), the presence of liver dysfunction and evidence of central nervous system (CNS) involvement tended to result in a fatal prognosis. All of the bacterial strains were found to be susceptible to vancomycin and quinolones (such as ciprofloxacin and levofloxacin), whereas many strains were resistant to clindamycin (76.9%) and imipenem (30.8%). In seven of 10 patients, central venous (CV) catheter tips were removed and routinely cultured. Catheter tip cultures were positive for B. cereus in three of seven patients.
Although not specific to B. cereus bacteremia, patients who died of B. cereus tended to present with CNS symptoms and/or liver dysfunction. Our clinical data suggested that carbapenem and clindamycin are no longer appropriate choices for treating B. cereus. In addition, B. cereus septicemia was found to frequently originate from CV catheters. Constant attention must be paid to update assessments of antibiotic susceptibility and careful management must be applied to CV catheters in patients with hematologic diseases.
蜡样芽孢杆菌败血症是血液系统疾病患者发生危及生命感染的一个病因。然而，由于临床研究不足，尚未实现预防蜡样芽孢杆菌感染患者的致命预后。为了发现更优化的治疗策略，我们分析了血液系统疾病患者的蜡样芽孢杆菌败血症。
在我们机构，2001年1月至2010年9月期间，我们观察了12例血液系统疾病患者中的13例蜡样芽孢杆菌败血症病例。还分析了蜡样芽孢杆菌菌株对抗生素的敏感性。
12例患者中，4例死于蜡样芽孢杆菌败血症。在本研究中，适当抗生素的延迟使用（出现症状>24小时后开始使用）、肝功能障碍的存在以及中枢神经系统（CNS）受累的证据往往导致致命预后。所有菌株均对万古霉素和喹诺酮类药物（如环丙沙星和左氧氟沙星）敏感，而许多菌株对克林霉素（76.9%）和亚胺培南（30.8%）耐药。10例患者中有7例拔除了中心静脉（CV）导管尖端并进行常规培养。7例患者中有3例导管尖端培养出蜡样芽孢杆菌阳性。
虽然并非蜡样芽孢杆菌菌血症所特有，但死于蜡样芽孢杆菌感染的患者往往出现中枢神经系统症状和/或肝功能障碍。我们的临床数据表明，碳青霉烯类和克林霉素不再是治疗蜡样芽孢杆菌的合适选择。此外，发现蜡样芽孢杆菌败血症常起源于中心静脉导管。必须持续关注抗生素敏感性评估的更新，并对血液系统疾病患者的中心静脉导管进行仔细管理。
