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与短肠综合征相关的克氏库克菌感染:一例报告

Kocuria kristinae infection associated with short bowel syndrome: A case report.

作者信息

Namba Yosuke, Fujisaki Seiji, Fukuda Toshikatsu

机构信息

Department of Surgery, Chugoku Rosai Hospital, Japan.

Department of Surgery, Chugoku Rosai Hospital, Japan; Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan.

出版信息

Int J Surg Case Rep. 2020;77:276-278. doi: 10.1016/j.ijscr.2020.11.006. Epub 2020 Nov 5.

Abstract

INTRODUCTION

Only a few cases of K. kristinae infection have been reported in the literature. Patients with short bowel syndrome have an increased risk of opportunistic infections due to decreased bowel immunity and the long-term central venous catheter placement. We report a rare case of K. kristinae infection associated with SBS requiring long-term central venous access port placement.

PRESENTATION OF CASE

A 70-year-old woman presented with fever of approximately 39 °C to our hospital for examination. She has undergone total hysterectomy and radiation therapy for cervical cancer 36 years ago. Five years ago, she developed multiple small bowel perforations, and a jejunostomy was constructed at the oral end of the perforation and approximately 110 cm from the ligament of Treitz because of the difficulty in dissecting the adhesion. She developed short bowel syndrome, and the central venous port was constructed four years ago due to poor enteral nutrition. K. kristinae was detected in the central venous catheter tip and in two blood cultures. We administered intravenous vancomycin. After seven days of antibiotic treatment, both fever and inflammatory reaction improved, and the blood culture was negative. After 16 days of antibiotic treatment, we performed central venous port construction on the side opposite to the previous site.

CONCLUSION

Patients with short bowel syndrome have an increased risk of K. kristinae infections due to decreased bowel immunity and the long-term central venous port, and therefore, these patients should be followed up carefully.

摘要

引言

文献中仅报道了少数几例克里斯汀库克菌感染病例。短肠综合征患者由于肠道免疫力下降和长期留置中心静脉导管,发生机会性感染的风险增加。我们报告了一例罕见的与短肠综合征相关的克里斯汀库克菌感染病例,该患者需要长期放置中心静脉通路端口。

病例介绍

一名70岁女性因发热至我院就诊,体温约39°C。36年前她因宫颈癌接受了全子宫切除术和放射治疗。五年前,她出现多处小肠穿孔,由于粘连难以分离,在穿孔的口侧距屈氏韧带约110cm处行空肠造口术。她发展为短肠综合征,四年前因肠内营养不佳而置入中心静脉端口。在中心静脉导管尖端和两次血培养中检测到克里斯汀库克菌。我们给予静脉注射万古霉素。抗生素治疗7天后,发热和炎症反应均有所改善,血培养转阴。抗生素治疗16天后,我们在与先前部位相对的一侧进行了中心静脉端口构建。

结论

短肠综合征患者由于肠道免疫力下降和长期使用中心静脉端口,发生克里斯汀库克菌感染的风险增加,因此,应对这些患者进行密切随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaca/7672243/51e8f2c6d1b1/gr1.jpg

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