Osterwalder B, Frei R, Gratwohl A, Reber H, Speck B
Schweiz Med Wochenschr. 1986 Jun 28;116(26):880-4.
Corynebacterium species can normally be found on the skin and mucous membranes but rarely cause infections. They are sensitive to most antibiotics. Two patients with severe aplastic anemia undergoing antilymphocyte globulin therapy developed septicemia with a highly antibiotic-resistant corynebacterium (JK-group) only sensitive to vancomycin. Both patients had prolonged severe neutropenia, defects of the mucocutaneous barrier and intensive antibiotic treatment for gram negative infections. In both cases surveillance cultures already revealed the causative microorganism before fever started. One patient was even colonized with corynebacterium for several months before. If this strain is detected in the blood when new fever develops during prolonged neutropenia and broad-spectrum antibiotic therapy, it indicates serious infection in these highly compromised patients. Both cases illustrate that regular microbial surveillance can help to reveal colonization of high risk patients with multiple antibiotic-resistant corynebacterium strains and thus allow early initiation of treatment with vancomycin, which is the only effective antibiotic.
棒状杆菌通常可在皮肤和黏膜上发现，但很少引起感染。它们对大多数抗生素敏感。两名接受抗淋巴细胞球蛋白治疗的严重再生障碍性贫血患者发生了败血症，感染的是一种高度耐抗生素的棒状杆菌（JK组），仅对万古霉素敏感。两名患者均有长期严重中性粒细胞减少、皮肤黏膜屏障缺陷以及针对革兰氏阴性感染的强化抗生素治疗。在两例病例中，监测培养在发热开始前就已发现致病微生物。其中一名患者甚至在此前几个月就已被棒状杆菌定植。如果在长期中性粒细胞减少和广谱抗生素治疗期间出现新发热时在血液中检测到该菌株，则表明这些高度虚弱的患者发生了严重感染。这两例病例均说明，定期微生物监测有助于发现高危患者被多重耐药棒状杆菌菌株定植，从而能够早期开始使用唯一有效的抗生素万古霉素进行治疗。
