Service d'Anesthésie-Réanimation Chirurgicale, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
Unité Transversale de Traitement Des Infections (UT2I), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France.
Infection. 2020 Jun;48(3):413-420. doi: 10.1007/s15010-020-01411-w. Epub 2020 Mar 17.
Corynebacterium spp. (C. spp.) is commonly considered as a contaminant in respiratory specimens. No study has ever focused on its clinical relevance in the lower respiratory tract of patients admitted to the intensive care unit (ICU) and requiring mechanical ventilation. The aims were to describe the characteristics of ICU patients with a C. spp. positive deep respiratory specimen, to investigate the impact of C. spp. on the occurrence of pneumonia, and to evaluate the outcomes of these pneumonia.
We retrospectively included all adult patients admitted to ICU in a 1000-bed University Hospital (2007-2017) who had a C. spp. positive lower respiratory tract specimen at a significant quantitative level. We used clinical, radiological, and microbiological criteria to classify the likelihood of such pneumonia.
Among the 31 patients included, acute respiratory failure and postoperative care after major surgery were the main reasons of admission. SAPS II was 47 [34-60]. C. spp. pneumonia was considered as probable, possible and unlikely in 10, 14, and 7 patients, respectively. Fifty-two and 94% of C. spp. strains were sensitive to amoxicillin, and vancomycin/linezolid, respectively. Seventeen patients had a complete course of antibiotic against C. spp. The overall ICU mortality was 58%.
Corynebacterium spp seems to be responsible for authentic pneumonia in mechanically ventilated patients. It should be considered as clinically relevant when predominantly present in respiratory specimen from patients suspected with pneumonia in ICU, and empirically treated.
棒状杆菌属（Corynebacterium spp.）通常被认为是呼吸道标本中的污染菌。目前尚无研究关注其在入住重症监护病房（ICU）并需要机械通气的患者下呼吸道中的临床相关性。本研究旨在描述 ICU 中棒状杆菌属阳性深部呼吸道标本患者的特征，探讨棒状杆菌属对肺炎发生的影响，并评估这些肺炎的结局。
我们回顾性纳入了一家 1000 床位大学医院（2007-2017 年）所有成人 ICU 患者，这些患者的下呼吸道标本中棒状杆菌属呈显著定量阳性。我们使用临床、影像学和微生物学标准来对这类肺炎的可能性进行分类。
在纳入的 31 例患者中，急性呼吸衰竭和大手术后的术后护理是主要的入院原因。SAPS II 评分为 47 [34-60]。10、14 和 7 例患者的棒状杆菌属肺炎分别被认为是极可能、可能和不太可能的。52%和 94%的棒状杆菌属菌株分别对阿莫西林和万古霉素/利奈唑胺敏感。17 例患者接受了针对棒状杆菌属的完整抗生素疗程。总的 ICU 死亡率为 58%。
棒状杆菌属似乎是机械通气患者真实肺炎的病原体。当 ICU 中疑似肺炎患者的呼吸道标本中主要存在棒状杆菌属时，应将其视为临床相关菌，并进行经验性治疗。
