Summers Nathan A, Gharbin John, Friedman-Moraco Rachel, Lyon G Marshall, Lutgring Joseph
Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA.
Department of Global Health, Emory University, Atlanta, GA, USA.
JMM Case Rep. 2018 Dec 20;6(1):e005172. doi: 10.1099/jmmcr.0.005172. eCollection 2019 Jan.
is a commensal organism commonly colonizing the human gastrointestinal tract. Although it is generally a non-virulent organism, can cause significant morbidity and mortality due to its inherent and acquired resistances to commonly used antimicrobials. Patients who are immunosuppressed are particularly vulnerable.
A 65-75-year-old patient with a history of an orthotopic liver transplant for hepatitis C infection and diabetes was re-admitted to the hospital with abdominal pain and fever. The patient had several recent admissions related to the presentation reported here, which included treatment with a prolonged course of broad-spectrum antibiotics. The patient was found to have a recurrent liver abscess and blood cultures grew vancomycin-resistant , non-susceptible to all tested agents: ampicillin, penicillin, vancomycin, daptomycin and linezolid. The patient was started initially on chloramphenicol intravenously while awaiting additional susceptibility testing, which ultimately revealed chloramphenicol non-susceptibility. Tigecycline was started but the patient ultimately decided to pursue hospice care.
Multi-drug-resistant organisms are increasingly being recognized and are associated with poorer outcomes, particularly in immunosuppressed patients. We describe a particularly resistant organism and discuss potential therapeutic options.
是一种常见的共生生物，通常定殖于人类胃肠道。尽管它一般是无毒力的生物，但由于其对常用抗菌药物的固有耐药性和获得性耐药性，可导致显著的发病率和死亡率。免疫抑制患者尤其易受影响。
一名65 - 75岁的患者，有丙型肝炎感染和糖尿病史，接受过原位肝移植，因腹痛和发热再次入院。该患者近期有几次与此处报告的症状相关的入院治疗，其中包括接受了长时间的广谱抗生素治疗。发现该患者患有复发性肝脓肿，血培养结果显示分离出耐万古霉素的 ，对所有测试药物均不敏感：氨苄西林、青霉素、万古霉素、达托霉素和利奈唑胺。在等待进一步药敏试验期间，患者最初接受静脉注射氯霉素治疗，最终结果显示对氯霉素不敏感。开始使用替加环素治疗，但患者最终决定接受临终关怀。
多重耐药生物越来越受到关注，并且与较差的预后相关，特别是在免疫抑制患者中。我们描述了一种特别耐药的生物并讨论了潜在的治疗选择。
