Luna Arana Carmen, García-Morín Marina, Sánchez Carrillo Carlos, Rincón-López Elena
Hospital General Universitario Gregorio Marañón, Madrid, España.
Andes Pediatr. 2022 Apr;93(2):259-264. doi: 10.32641/andespediatr.v93i2.3921.
Catheter-related bacteriemia by Cupriavidus spp. is a rare condition with very few cases reported in the literature. Most of them occurred in immunocompromised patients.
To report a case of recurrent catheter-related bacteriemia by Cupriavidus pauculus in an immunocompromised infant in order to analyze possible therapeutic options, especially in relation to the need or not for central venous catheter (CVC) removal.
22-month-old infant with B-cell acute lymphoblas tic leukemia (ALL) in reinduction phase, CVC carrier. He presented to the Emergency Room with fever without focus on examination. Blood tests were performed (without increase of acute phase reactants) and differential blood cultures (peripheral and CVC). He was hospitalized and empirical antibiotic therapy was started with intravenous fourth-generation cephalosporin (cefepime). After 24 hours, blood cultures were positive for Cupriavidus pauculus, growing first in the CVC culture. We maintained cefepime, adding catheter lock therapy with ciprofloxacin. Afterward, the infection was resolved, allowing us to keep the CVC. Seven months later, in the context of fever, Cupriavidus pauculus was again identified in CVC blood culture. We decided this time to remove the catheter, in addition to the administration of intravenous cefepime. The patient has not presented new episodes nine months after de removal of the CVC.
Catheter-related bacteremia by Cupriavidus is a rare condition in children that usually occurs in immunocompromised patients. Catheter lock therapy associated with systemic antibiotics could be a safe option in patients with difficult CVC re moval. However, if persistent colonization of the CVC is suspected, it may be necessary to remove it.
嗜麦芽窄食单胞菌引起的导管相关菌血症是一种罕见病症，文献报道的病例极少。大多数病例发生在免疫功能低下的患者中。
报告一例免疫功能低下婴儿发生的由少动鞘氨醇单胞菌引起的复发性导管相关菌血症病例，以分析可能的治疗选择，尤其是关于是否需要拔除中心静脉导管（CVC）。
一名22个月大的婴儿，处于B细胞急性淋巴细胞白血病（ALL）再诱导期，为CVC携带者。他因发热就诊于急诊室，体格检查未发现明确病灶。进行了血液检查（急性期反应物未升高）和差异血培养（外周血和CVC）。他住院并开始使用静脉注射第四代头孢菌素（头孢吡肟）进行经验性抗生素治疗。24小时后，血培养结果显示少动鞘氨醇单胞菌阳性，首先在CVC培养物中生长。我们维持使用头孢吡肟，并添加环丙沙星进行导管封管治疗。此后，感染得到解决，CVC得以保留。七个月后，在发热情况下，CVC血培养中再次发现少动鞘氨醇单胞菌。这次我们决定除了静脉注射头孢吡肟外，拔除导管。拔除CVC九个月后，患者未出现新的发作。
嗜麦芽窄食单胞菌引起的导管相关菌血症在儿童中是一种罕见病症，通常发生在免疫功能低下的患者中。对于难以拔除CVC的患者，导管封管治疗联合全身抗生素可能是一种安全的选择。然而，如果怀疑CVC持续定植，可能有必要拔除它。
