Arbune Manuela, Fotea Silvia, Nechita Aurel, Stefanescu Victorita
"Dunarea de Jos" University, Medicine and Pharmacy Research Centre, Galati Romania.
Infectious Diseases Clinical Hospital Galati, Galati Romania.
J Crit Care Med (Targu Mures). 2018 Jul 1;4(3):96-100. doi: 10.2478/jccm-2018-0013. eCollection 2018 Jul.
are Gram-negative rod bacteria which are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards.
Here, we present the case of a premature female infant born at 33 weeks' gestational age, with neonatal meningitis. The onset was marked by fever, in the 5th day of life, while in the Neonatal Intensive Care Unit. The patient was commenced on Gentamicin and Ampicillin, but her clinical condition worsened. Psychomotor agitation and food refusal developed in the 10th day of life, and a diagnosis of bacterial meningitis was made based on clinical and cerebrospinal fluid findings. A strain of sensitive to Vancomycin, Rifampicin and Clarithromycin was isolated from cerebrospinal fluid. First-line antibiotic therapy with Meropenem and Vancomycin was adjusted by replacing Meronem with Piperacillin/Tazobactam and Rifampicin. The patient's clinical condition improved, although some isolated febrile episodes were still present. The cerebrospinal fluid was normalized after 6 weeks of antibiotic treatment, although periventriculitis and tetraventricular hydrocephalus were revealed by imaging studies. Neurosurgical drainage was necessary.
can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for case management.
是革兰氏阴性杆菌,常见于环境中。这种细菌也与医院感染有关,曾在受污染的医疗设备上分离出来,尤其是在新生儿病房。
在此,我们报告一例孕33周出生的早产女婴,患有新生儿脑膜炎。发病以出生第5天在新生儿重症监护病房出现发热为标志。患者开始使用庆大霉素和氨苄西林治疗,但临床状况恶化。出生第10天出现精神运动性激惹和拒食,根据临床和脑脊液检查结果诊断为细菌性脑膜炎。从脑脊液中分离出一株对万古霉素、利福平及克拉霉素敏感的菌株。一线抗生素治疗由美罗培南和万古霉素调整为用哌拉西林/他唑巴坦和利福平替代美罗培南。患者临床状况有所改善,尽管仍有一些孤立的发热发作。抗生素治疗6周后脑脊液恢复正常,尽管影像学检查显示有脑室周围炎和四脑室脑积水。需要进行神经外科引流。
可导致严重感染,新生儿死亡率和神经后遗症风险高。重症监护和多学科干预对病例管理至关重要。