Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
J Clin Microbiol. 2023 Feb 22;61(2):e0173322. doi: 10.1128/jcm.01733-22. Epub 2023 Jan 30.
species are anaerobic, Gram-negative bacilli increasingly recognized as pathogens capable of causing invasive infections such as bloodstream infection (BSI), particularly among immunocompromised patients. However, there is a paucity of data regarding epidemiology, antimicrobial susceptibility, optimal treatment, and clinical outcomes among patients with bacteremia. Patient risk factors, treatment approaches, and outcomes of a retrospective cohort of adult patients with BSI at a tertiary medical center (Mayo Clinic Rochester [MCR]) were evaluated. Concurrently, species, temporal trends, and antimicrobial susceptibility testing (AST) results of isolates submitted to a reference laboratory (Mayo Clinic Laboratories) over the past 10 years were examined. We identified 224 blood culture isolates of species, with 26 isolates from patients treated at MCR. The most frequent species included L. trevisanii (49%), L. buccalis (24%), and L. wadei (16%). species demonstrated >90% susceptibility to penicillin, metronidazole, ertapenem, and piperacillin-tazobactam. However, 96% (74/77) of isolates were resistant to moxifloxacin. For patients treated at MCR, the mean patient age was 55 years (standard deviation [SD], 17), with 9 females (35%), and all were neutropenic at the time of BSI. The primary sources of infection were gastrointestinal (58%), intravascular catheter (35%), and odontogenic (15%). Patients were treated with metronidazole (42%), piperacillin-tazobactam (27%), or carbapenems (19%). The mean duration of treatment was 11 days (SD, 4.5), with a 60-day all-cause mortality of 19% and no microbiologic relapse. species are rare but important causes of BSI in neutropenic patients. Due to evolving antimicrobial susceptibility profiles, a review of AST results is necessary when selecting optimal antimicrobial therapy.
物种是厌氧的革兰氏阴性杆菌,越来越多地被认为是能够引起侵袭性感染的病原体,如血流感染(BSI),特别是在免疫功能低下的患者中。然而,关于血液感染患者的流行病学、抗菌药物敏感性、最佳治疗和临床结局的数据很少。在罗切斯特梅奥诊所(Mayo Clinic Rochester [MCR])的一家三级医疗中心,对回顾性成人患者 BSI 病例队列的患者危险因素、治疗方法和结局进行了评估。同时,对过去 10 年来向参考实验室(Mayo Clinic Laboratories)提交的 种分离株的种、时间趋势和抗菌药物敏感性检测(AST)结果进行了检查。我们确定了 224 株 种血培养分离株,其中 26 株来自 MCR 治疗的患者。最常见的种包括 L. trevisanii(49%)、L. buccalis(24%)和 L. wadei(16%)。 种对青霉素、甲硝唑、厄他培南和哌拉西林他唑巴坦的敏感性>90%。然而,96%(74/77)的分离株对莫西沙星耐药。对于在 MCR 治疗的患者,平均患者年龄为 55 岁(标准差[SD],17),女性 9 例(35%),BSI 时均为中性粒细胞减少症。感染的主要来源是胃肠道(58%)、血管内导管(35%)和牙源性(15%)。患者接受甲硝唑(42%)、哌拉西林他唑巴坦(27%)或碳青霉烯类药物(19%)治疗。治疗平均持续时间为 11 天(SD,4.5),60 天全因死亡率为 19%,无微生物学复发。 种是中性粒细胞减少症患者血流感染的罕见但重要病因。由于抗菌药物敏感性谱不断演变,在选择最佳抗菌药物治疗时,需要对 AST 结果进行审查。