Abe Masahiro, Kimura Muneyoshi, Maruyama Hideyuki, Watari Tomohisa, Ogura Sho, Takagi Shinsuke, Uchida Naoyuki, Otsuka Yoshihito, Taniguchi Shuichi, Araoka Hideki
Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
Department of Laboratory Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan.
Eur J Clin Microbiol Infect Dis. 2021 Oct;40(10):2095-2104. doi: 10.1007/s10096-021-04257-8. Epub 2021 Apr 24.
The aim of this study was to clarify the clinical and microbiological characteristics of Corynebacterium bacteremia in hematological patients. We retrospectively reviewed the medical records of patients with Corynebacterium bacteremia from April 2013 to June 2018. The causative Corynebacterium species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Drug susceptibility tests were performed using the broth microdilution method recommended by the Clinical and Laboratory Standards Institute. In total, 147 cases of Corynebacterium bacteremia were identified during the study period. Corynebacterium striatum was the most frequent pathogen. Catheter-related bloodstream infection was diagnosed in 19.7% of all patients, and moderate/severe oral or severe gastrointestinal mucosal impairment was detected in 19.7%. Polymicrobial infection was found in about 20% of cases, with Enterococcus faecium being the most frequent isolate. The overall 30-day mortality was 34.7% (51/147). Multivariate analysis showed that E. faecium co-infection (odds ratio (OR) 9.3; 95% confidence interval (CI) 2.1-40), systemic corticosteroids (OR 3.6; 95% CI 1.4-8.9), other immunosuppressive drugs (OR 0.32; 95% CI 0.13-0.76), and a Pitt bacteremia score ≥4 (OR 12; 95% CI 3.9-40) were significant risk factors for overall 30-day mortality. The drug susceptibility rates for beta-lactam antimicrobial agents were quite low. All isolates were susceptible to glycopeptides and linezolid. However, some C. striatum isolates were resistant to daptomycin. Corynebacterium bacteremia can occur in the presence of several types of mucosal impairment. Our drug susceptibility data indicate that Corynebacterium bacteremia in hematological patients could be treated by glycopeptides or linezolid.
本研究的目的是阐明血液病患者棒状杆菌血症的临床和微生物学特征。我们回顾性分析了2013年4月至2018年6月期间棒状杆菌血症患者的病历。使用基质辅助激光解吸/电离飞行时间质谱法鉴定致病棒状杆菌种类。采用临床和实验室标准协会推荐的肉汤微量稀释法进行药敏试验。在研究期间共鉴定出147例棒状杆菌血症病例。纹带棒状杆菌是最常见的病原体。19.7%的患者被诊断为导管相关血流感染，19.7%的患者检测到中度/重度口腔或严重胃肠道黏膜损伤。约20%的病例发现有多种微生物感染，粪肠球菌是最常见的分离菌株。总体30天死亡率为34.7%（51/147）。多因素分析显示，粪肠球菌合并感染（比值比（OR）9.3；95%置信区间（CI）2.1 - 40）、全身使用糖皮质激素（OR 3.6；95%CI 1.4 - 8.9）、其他免疫抑制药物（OR 0.32；95%CI 0.13 - 0.76）以及皮特菌血症评分≥4（OR 12；95%CI 3.9 - 40）是总体30天死亡率的显著危险因素。β-内酰胺类抗菌药物的药敏率相当低。所有分离株对糖肽类和利奈唑胺敏感。然而，一些纹带棒状杆菌分离株对达托霉素耐药。棒状杆菌血症可在多种类型的黏膜损伤情况下发生。我们的药敏数据表明，血液病患者的棒状杆菌血症可用糖肽类或利奈唑胺治疗。
