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横纹肉杆菌性心内膜炎一例,早期转换为口服抗菌治疗获得成功。

A case of Corynebacterium striatum endocarditis successfully treated with an early switch to oral antimicrobial therapy.

机构信息

Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

出版信息

Infez Med. 2021 Mar 1;29(1):138-144.

Abstract

Patients with Corynebacterium striatum endocarditis are usually managed with long-term intravenous antibiotic therapy and hospitalization. Here we describe a case of a 76-year-old woman with hepatitis C virus (HCV) related cirrhosis who developed endocarditis due to Corynebacterium striatum associated with severe aortic regurgitation. To our knowledge, this is the first case to be successfully treated with an early switch to oral linezolid after three weeks of vancomycin. We performed a literature review using the PubMed database and found 27 cases which showed the enhanced virulence of this pathogen especially for long-term hospitalized patients with a frequent need of surgical treatment (44.4%) and long course of parenteral antimicrobial therapy, with vancomycin as drug of choice. There are no studies confirming the possibility of using oral treatment in non-diphtheritic Corynebacteria infective endocarditis. This case report provides us with the evidence that once the patient is in a stable condition, the efficacy and safety of linezolid might be similar to vancomycin administration. New trials and prospective studies are needed to confirm the opportunity of an early switch to oral therapy in this specific setting.

摘要

患者 Corynebacterium striatum 心内膜炎通常采用长期静脉内抗生素治疗和住院治疗。在这里,我们描述了一例 76 岁的妇女,患有丙型肝炎病毒 (HCV) 相关的肝硬化,由于与严重主动脉瓣反流相关的 Corynebacterium striatum 而发生心内膜炎。据我们所知,这是首例在万古霉素治疗 3 周后早期改用口服利奈唑胺成功治疗的病例。我们使用 PubMed 数据库进行了文献回顾,发现了 27 例病例,这些病例显示了这种病原体的毒力增强,特别是对于长期住院且经常需要手术治疗(44.4%)和长期静脉内抗菌治疗的患者,万古霉素是首选药物。没有研究证实非白喉 Corynebacterium 感染性心内膜炎可采用口服治疗。本病例报告为我们提供了证据,即一旦患者病情稳定,利奈唑胺的疗效和安全性可能与万古霉素相似。需要新的试验和前瞻性研究来证实在此特定情况下早期转为口服治疗的机会。

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