Department of Clinical Laboratory Medicine, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, China (mainland).
Department of General Surgery, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, China (mainland).
Am J Case Rep. 2022 May 8;23:e936329. doi: 10.12659/AJCR.936329.
BACKGROUND Clostridium perfringens (CP), one of several clostridial species gram-positive bacteria, is a major cause of animal necrosis enteritis and traumatic gangrene. In some reports, CP can cause acute emphysematous cholecystitis in patients with biliary tract infections. However, C. perfringens combined with other aerobic bacteria (eg, E. coli) in bloodstream co-infection is extremely rare and often fatal. Herein, we present a case of co-infection to underscore this unusual situation so that clinicians can adequately evaluate and treat patients in time. CASE REPORT A 74-year-old man presented to the Emergency Department half a day after the onset of acute abdominal pain accompanied by nausea, vomiting, and chills. The patient was admitted, following development of jaundice, chills, high fever, confusion, and shock. Computed tomography (CT) revealed that the patient had cholangiectasis with acute obstructive suppurative cholangitis (AOSC). We subsequently performed percutaneous transhepatic gallbladder drainage surgery combined with antibiotics, including ceftriaxone, levofloxacin, and metronidazole. C. perfringens and Escherichia coli infections were identified by in vitro blood culture. Fortunately, the patient responded favorably to treatment in our hospital and was cured within 1 week. CONCLUSIONS We report a rare case of C. perfringens and E. coli bloodstream co-infection in a patient with AOSC. We suggest that anaerobic and aerobic co-infection should be considered in future clinical diagnoses. Effective antibiotic treatment combined with surgical drainage is crucial if mixed infection occurs.
梭状芽孢杆菌（CP）是几种梭状芽孢杆菌革兰氏阳性菌之一，是动物坏死性肠炎和创伤性坏疽的主要原因。在一些报告中，CP 可引起胆道感染患者的急性气肿性胆囊炎。然而，CP 与其他需氧菌（例如大肠杆菌）在血流中的合并感染极为罕见，且常致命。在此，我们报告一例合并感染病例，以强调这种不常见的情况，以便临床医生能够及时充分评估和治疗患者。
一名 74 岁男性在急性腹痛发作半天后就诊，伴有恶心、呕吐和寒战。患者出现黄疸、寒战、高热、意识模糊和休克后被收入院。计算机断层扫描（CT）显示患者有胆管扩张伴急性化脓性胆管炎（AOSC）。随后，我们进行了经皮经肝胆囊引流术，并联合使用抗生素，包括头孢曲松、左氧氟沙星和甲硝唑。通过体外血液培养鉴定出梭状芽孢杆菌和大肠杆菌感染。幸运的是，患者在我院治疗反应良好，1 周内治愈。
我们报告了一例罕见的 AOSC 患者梭状芽孢杆菌和大肠杆菌血流合并感染病例。我们建议在未来的临床诊断中应考虑厌氧和需氧混合感染。如果发生混合感染，有效的抗生素治疗联合手术引流至关重要。
