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[医院内嗜柠檬酸弯曲菌(H. cinaedi)的临床及细菌学检查]

[Clinical and bacteriological examination in hospital of Helicobacter cinaedi (H. cinaedi)].

作者信息

Kawakami Yoko

出版信息

Kansenshogaku Zasshi. 2014 Jul;88(4):417-22. doi: 10.11150/kansenshogakuzasshi.88.417.

Abstract

The spiral Gram-negative bacterium Helicobacter cinaedi (H. cinaedi) is usually isolated from immunocompromized patients, and the number of patients in whom H. cinaedi is isolated from their blood culture is increasing in Japan. To elucidate why the number of cases is increasing, we tried to analyze separate cases of H. cinaedi. H. cinaedi was isolated from the blood culture of 24 cases, and the isolate was from the pleural effusion of 1 cases between September 2009 and March 2010. In our cases, H. cinaedi was frequently isolated after anticancer chemotherapies (44 isolates) and steroid therapies (42 isolates). The patients' clinical symptoms were fever (43 isolates), gastrointestinal symptoms (4 isolates) and skin symptoms (8 isolates). In all cases, the H. cinaedi growth was found only in an aerobic bottle, and it needed a long time (2-7 days) to grow. In 14 cases out of 25 cases, H. cinaedi bacteremia was recurred. We analyzed recurrent cases statistically. The result showed there was a significant difference between the kinds of quinolones (p = 0.0018). H. cinaedi infections have a good prognosis, but the infection tends to recur after anticancer chemotherapies. A report has suggested that the minimal inhibitory concentrations of quinolones increased is case of recurrence, we should pay attention to the use of antibacterial agents. Furthermore, the effective method to eliminate or prevert infection [recurrence] remains unknown. Our results show that H. cinaedi infections may prolong the duration of hospitalization. If H. cinaedi is isolated in a patient, it is necessary to set the culture conditions for H. cinaedi. Furthermore, there is a need for appropiate antibiotic selection and medication for H. cinaedi.

摘要

嗜肺埃希杆菌(H. cinaedi)是一种革兰氏阴性螺旋菌,通常从免疫功能低下的患者中分离出来,在日本,从血培养中分离出嗜肺埃希杆菌的患者数量正在增加。为了阐明病例数量增加的原因,我们尝试分析嗜肺埃希杆菌的个别病例。在2009年9月至2010年3月期间,从24例患者的血培养中分离出嗜肺埃希杆菌,其中1例分离株来自胸腔积液。在我们的病例中,嗜肺埃希杆菌常在抗癌化疗(44株)和类固醇治疗(42株)后频繁分离出来。患者的临床症状包括发热(43株)、胃肠道症状(4株)和皮肤症状(8株)。在所有病例中,嗜肺埃希杆菌仅在需氧瓶中生长,且生长需要很长时间(2 - 7天)。25例中有14例出现嗜肺埃希杆菌菌血症复发。我们对复发病例进行了统计学分析。结果显示喹诺酮类药物种类之间存在显著差异(p = 0.0018)。嗜肺埃希杆菌感染预后良好,但在抗癌化疗后感染容易复发。一份报告表明,复发时喹诺酮类药物的最低抑菌浓度会增加,我们应注意抗菌药物的使用。此外,消除或预防感染[复发]的有效方法仍然未知。我们的结果表明,嗜肺埃希杆菌感染可能会延长住院时间。如果在患者中分离出嗜肺埃希杆菌,有必要为其设定培养条件。此外,需要为嗜肺埃希杆菌选择合适的抗生素并进行用药。

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