Yao Caroline A, Wang Diana, Kulber David A
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. ; Center for Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Arch Plast Surg. 2014 Jul;41(4):414-7. doi: 10.5999/aps.2014.41.4.414. Epub 2014 Jul 15.
Serratia marcescens (S. marcescens) emerged as an opportunist in the setting of immunodeficiency in the 1970s, when serious infections occurred in San Francisco hospitals after USA. Navy experiments had aerosolized the bacteria to study biologic warfare. We investigate the risks of S. marcescens in San Franciscans who undergo mastectomy with implant reconstruction. From 2007 to 2011, the senior author took breast capsule cultures for all patients at the time of tissue expander exchange/explant. Of the 142 women who had reconstruction, 23 had positive cultures. Only the two patients who were positive for S. marcescens developed clinical infections that required explantation. Both had postoperative chemotherapy with transient neutropenia, and both had close ties to San Francisco. Clinical signs of infection emerged for both patients months after initial surgery, despite having previously well healed incisions. Other patients were culture positive for Pseudomonas, Proteus, Enterococcus and MRSA and did not develop require explant. While the link between San Francisco and S. marcescens is controversial, a patient's geography is a simple screening tool when considering postoperative risks, especially in the immunocompromised. Closer monitoring for neutropenia during chemotherapy, and a lower threshold to administer S. marcescens targeted antibiotics may be warranted in these patients.
粘质沙雷氏菌在20世纪70年代作为一种免疫缺陷情况下的机会致病菌出现，当时在美国海军对该细菌进行雾化以研究生物战之后，旧金山的医院发生了严重感染。我们调查了在旧金山接受乳房切除并植入重建手术的患者感染粘质沙雷氏菌的风险。2007年至2011年，资深作者在组织扩张器更换/取出时对所有患者进行了乳房包膜培养。在142名接受重建手术的女性中，23人的培养结果呈阳性。只有两名粘质沙雷氏菌培养阳性的患者发生了需要取出植入物的临床感染。两人均接受了术后化疗并出现短暂性中性粒细胞减少，且两人都与旧金山有密切联系。尽管最初手术的切口此前已愈合良好，但两名患者在初次手术后数月均出现了感染临床症状。其他患者假单胞菌、变形杆菌、肠球菌和耐甲氧西林金黄色葡萄球菌培养阳性，但未发生需要取出植入物的情况。虽然旧金山与粘质沙雷氏菌之间的联系存在争议，但在考虑术后风险时，尤其是免疫功能低下的患者，患者所在地区是一种简单易行的筛查工具。对于这些患者，化疗期间更密切地监测中性粒细胞减少情况，以及降低使用针对粘质沙雷氏菌的抗生素的阈值可能是必要的。
