Medical College of Georgia, WellStar MCG Health, Augusta, GA, USA.
VA Augusta Health Care System, Augusta, GA, USA.
J Investig Med High Impact Case Rep. 2024 Jan-Dec;12:23247096241239544. doi: 10.1177/23247096241239544.
(formerly classified as ) is a gram-negative bacillus (GNB) that occurs as an opportunistic pathogen in neonates and immunocompromised patients. species have been implicated in nosocomial settings leading to infections involving the urinary tract, respiratory tract, liver, biliary tract, meninges, and even in rarer conditions-blood stream infection and infective endocarditis (IE). Gram-negative bacilli are responsible for 3% to 4% of all IE cases and have been traditionally associated with intravenous drug users. Patients with non-HACEK (species other than species, species) GNB IE have poor clinical outcomes with higher rates of in-hospital mortality and complications. The American Heart Association (AHA) and Infectious Diseases Society of America (IDSA) both recommend the use of combination antibiotic therapy with a beta-lactam (penicillins, cephalosporins, or carbapenems) and either an aminoglycoside or fluoroquinolones for 6 weeks (about 1 and a half months) to treat IE due to non-HACEK GNB. is becoming more recognized due to its inherent resistance to ampicillin and emerging drug resistance to beta lactams and aminoglycosides requiring carbapenem therapy. Our case is of a 75-year-old male with no previously reported history of primary or secondary immunodeficiency disorders who developed blood stream infection. His infectious work-up revealed mitral valve IE and septic cerebral emboli resulting in ischemic infarcts. This case illustrates the importance of recognizing GNB organisms as rising human pathogens in IE cases even without active injection drug use or nosocomial exposure.
（以前被归类为）是一种革兰氏阴性杆菌（GNB），在新生儿和免疫功能低下的患者中作为机会性病原体出现。该物种已被牵连到医院环境中，导致涉及泌尿道、呼吸道、肝脏、胆道、脑膜的感染，甚至在更罕见的情况下——血流感染和感染性心内膜炎（IE）。革兰氏阴性杆菌占所有 IE 病例的 3%至 4%，传统上与静脉吸毒者有关。患有非 HACEK（非 物种、 物种）GNB IE 的患者临床结局较差，院内死亡率和并发症发生率较高。美国心脏协会（AHA）和传染病学会（IDSA）均建议使用联合抗生素治疗，使用β-内酰胺类（青霉素类、头孢菌素类或碳青霉烯类）加氨基糖苷类或氟喹诺酮类，治疗非 HACEK GNB 引起的 IE 6 周（约 1 个半月）。由于其对氨苄西林的固有耐药性以及对β内酰胺类和氨基糖苷类药物的新兴耐药性，需要碳青霉烯类治疗。我们的病例是一名 75 岁男性，无原发性或继发性免疫功能缺陷疾病的既往报告史，他发生了血流感染。他的感染性检查结果显示二尖瓣 IE 和败血症性脑栓塞导致缺血性梗死。该病例说明了认识到 GNB 生物体作为 IE 病例中不断增加的人类病原体的重要性，即使没有主动静脉吸毒或医院暴露。
