Kimura Shun-Ichi, Gomyo Ayumi, Hayakawa Jin, Akahoshi Yu, Harada Naonori, Ugai Tomotaka, Komiya Yusuke, Kameda Kazuaki, Wada Hidenori, Ishihara Yuko, Kawamura Koji, Sakamoto Kana, Sato Miki, Terasako-Saito Kiriko, Kikuchi Misato, Nakasone Hideki, Kanda Junya, Kako Shinichi, Tanihara Aki, Kanda Yoshinobu
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
J Infect Chemother. 2017 Mar;23(3):148-153. doi: 10.1016/j.jiac.2016.11.007. Epub 2016 Dec 20.
We examined the clinical characteristics and predictive factors for mortality in coryneform bacteria bloodstream infection in hematological patients.
We searched for hematological patients who had positive blood cultures for coryneform bacteria at our center between April 2007 and January 2016. Patients with definite bloodstream infections were included. We started species identification in April 2014.
Twenty of twenty-eight cases with a positive blood culture for coryneform bacteria were regarded as definite infections. Sixteen and two patients were allogeneic and autologous hematopoietic stem cell transplantation (HSCT) recipients, respectively. Corynebacterium striatum was identified in all nine of the cases tested and one patient was co-infected with Corynebacterium amycolatum. None of the patients died directly due to coryneform bacteria infection. The survival rates at 30, 60 and 180 days were 100%, 73.7% and 51.3%, respectively. Causes of mortality included progression of the underlying disease (n = 6), other infections (n = 4) and HSCT complications (n = 2). Mixed infection (hazard ratio (HR) 5.47, 95% confidence interval (CI) 1.30-23.0), renal impairment (HR 6.31, 95% CI 1.06-37.4) and absence of a central venous (CV) catheter at the onset (HR 6.39, 95% CI 1.04-39.45) were identified as predictive factors for mortality.
Most of the coryneform bacteria bloodstream infections occurred in HSCT recipients. Contamination seemed to be less common when coryneform bacteria were detected in blood in hematological patients. Although coryneform bacteria bloodstream infection seemed to mostly be manageable, the prognosis was not desirable, particularly in patients with mixed infection, renal impairment and absence of a CV catheter.
我们研究了血液系统疾病患者棒状杆菌血流感染的临床特征及死亡预测因素。
我们在2007年4月至2016年1月期间，在本中心寻找血培养棒状杆菌呈阳性的血液系统疾病患者。纳入确诊为血流感染的患者。我们于2014年4月开始进行菌种鉴定。
28例血培养棒状杆菌呈阳性的病例中，20例被视为确诊感染。其中16例和2例患者分别为异基因和自体造血干细胞移植（HSCT）受者。在所有检测的9例病例中均鉴定出纹带棒状杆菌，1例患者合并无糖棒状杆菌感染。无一例患者直接死于棒状杆菌感染。30天、60天和180天的生存率分别为100%、73.7%和51.3%。死亡原因包括基础疾病进展（n = 6）、其他感染（n = 4）和HSCT并发症（n = 2）。混合感染（风险比（HR）5.47，95%置信区间（CI）1.30 - 23.0）、肾功能损害（HR 6.31，95% CI 1.06 - 37.4）和发病时无中心静脉（CV）导管（HR 6.39，95% CI 1.04 - 39.45）被确定为死亡的预测因素。
大多数棒状杆菌血流感染发生在HSCT受者中。血液系统疾病患者血液中检测到棒状杆菌时，污染似乎不太常见。虽然棒状杆菌血流感染似乎大多可控制，但预后不佳，尤其是在合并混合感染、肾功能损害和无CV导管的患者中。
