Maruki Taketomo, Taniyama Daisuke, Tsuchiya Yumi, Adachi Tomohide
Department of Infectious Diseases, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
IDCases. 2020 Jun 27;21:e00893. doi: 10.1016/j.idcr.2020.e00893. eCollection 2020.
Herein, we report a case of breakthrough and persistent bacteremia due to serotype K1 in an immunocompetent 53- year-old man. He was diagnosed with pyogenic spondylitis owing to back pain and based on magnetic resonance imaging findings. On admission, several imaging studies were taken to search for other abscesses and infective endocarditis; however, there were no significant findings. Additionally, blood cultures were negative. Upon treatment with intravenous ampicillin/sulbactam, the patient's symptoms improved. However, eleven days after admission, the patient experienced a fever and worsening back pain. Blood cultures were taken again, and was detected, which showed sensitivity to ampicillin/sulbactam. Fourteen days after admission, was detected again, suggesting breakthrough and persistent bacteremia with . The source of the infection was unknown. The antimicrobial regimen was changed to a combination of ceftriaxone and gentamicin. Sixty days after admission, the patient was discharged without any sequelae. The isolated strains were found to carry and were confirmed as serotype K1; thus, detected hypervirulent (HvKP). HvKP is an increasingly recognized pathotype of characterized clinically by its ability to cause organ- or life-threatening infections in healthy persons. To the best of our knowledge, our case is the first report of spondylitis due to confirmed HvKP. Moreover, HvKP caused breakthrough and persistent bacteremia on an immunocompetent patient.
在此，我们报告一例53岁免疫功能正常男性因K1血清型导致的突破性和持续性菌血症病例。他因背痛并基于磁共振成像结果被诊断为化脓性脊柱炎。入院时，进行了多项影像学检查以寻找其他脓肿和感染性心内膜炎；然而，未发现明显异常。此外，血培养结果为阴性。静脉注射氨苄西林/舒巴坦治疗后，患者症状有所改善。然而，入院11天后，患者出现发热且背痛加重。再次进行血培养，检测到[病原体名称未明确写出]，对氨苄西林/舒巴坦敏感。入院14天后，再次检测到[病原体名称未明确写出]，提示[病原体名称未明确写出]导致的突破性和持续性菌血症。[病原体名称未明确写出]感染源不明。抗菌治疗方案改为头孢曲松和庆大霉素联合使用。入院60天后，患者出院，无任何后遗症。分离出的[病原体名称未明确写出]菌株携带[相关基因未明确写出]并被确认为K1血清型；因此，检测到高毒力[病原体名称未明确写出]（HvKP）。HvKP是一种越来越被认可的[病原体名称未明确写出]致病型，其临床特征是能够在健康人群中引起器官或危及生命的感染。据我们所知，我们的病例是首例因确诊的HvKP导致脊柱炎的报告。此外，HvKP在一名免疫功能正常的患者中引起了突破性和持续性菌血症。
