儿童颗粒性鲍曼不动杆菌菌血症：两例病例报告及文献复习。
Granulicatella bacteraemia in children: two cases and review of the literature.
机构信息
Unit of Immunology and Infectious Disease, University Hospital Pediatric Department, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, Rome, Italy.
出版信息
BMC Pediatr. 2013 Apr 22;13:61. doi: 10.1186/1471-2431-13-61.
BACKGROUND
Granulicatella spp. is a fastidious bacteria responsible for bacteremia and endocarditis which are fatal in about 20% of the cases. These severe infections are uncommon in children under 17 years of age and have proven extremely difficult to treat.
CASES PRESENTATION
We report a brief review of the literature and two cases of NVS bacteremia by Granulicatella complicated by infective endocarditis (IE). The first one is that of a 7-year-old Caucasian female with Shone syndrome and IE involving the pulmonary valve homograft, confirmed by echocardiography. The second case is that of a 5-year-old Caucasian male. In this patient echocardiogram was negative for signs of IE; however, a "possible" IE was suspected on the basis of a cardiac catheterization 3 weeks before the onset of fever. Since in both our patients clinical failure of first line antibiotic treatment was observed, we used a combination of meropenem with another anti-streptococcal drug with excellent results.
CONCLUSION
In Granulicatella bacteremia in the pediatric population, combination antimicrobial therapy including meropenem should be considered as a second line treatment in non-responding patients.
背景
颗粒单胞菌是一种苛刻的细菌，可引起菌血症和心内膜炎，约有 20%的病例是致命的。这些严重感染在 17 岁以下的儿童中并不常见，且极难治疗。
病例介绍
我们报告了文献综述和两例由颗粒单胞菌引起的 NVS 菌血症合并感染性心内膜炎（IE）的病例。第一个病例是一名 7 岁白人女性，患有 Shone 综合征和累及肺动脉同种移植物的 IE，经超声心动图证实。第二个病例是一名 5 岁白人男性。在该患者中，超声心动图未发现 IE 的迹象；然而，在发热前 3 周的心脏导管检查中，怀疑存在“可能”的 IE。由于我们的两位患者在一线抗生素治疗后均出现临床治疗失败，因此我们使用了美罗培南联合另一种抗链球菌药物的联合治疗，效果极佳。
结论
在儿科人群中，对于颗粒单胞菌菌血症患者，包括美罗培南在内的联合抗菌治疗应被视为对无反应患者的二线治疗。
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