Hong Xiaoyan, Huang Yangrong, Lin Wei, Zhang Yi, Lin Jianyun, Zhang Shengguo, Cai Fengquan, Chen Jie
Department of Emergency, Third Affiliated Hospital of Wenzhou Medical University (Rui'an People's Hospital), Wenzhou, Zhejiang, People's Republic of China.
Department of Infection, Third Affiliated Hospital of Wenzhou Medical University (Rui'an People's Hospital), Wenzhou, Zhejiang, People's Republic of China.
Infect Drug Resist. 2024 Sep 25;17:4185-4194. doi: 10.2147/IDR.S479043. eCollection 2024.
infection is readily disseminated, yet the multiple septic arthritis and extensive migratory skin and soft tissue infections it causes are uncommon and challenging to treat. The infection can be life-threatening, with a mortality rate of 15-31%. Early, targeted antibiotic therapy is critical to improve prognosis. However, routine cultures are time-consuming and have low positivity rates, which may lead to errors in antibiotic regimen selection, depriving patients of optimal treatment. Genetic testing technologies, such as macrogenomic next-generation sequencing (mNGS) and digital polymerase chain reaction (dPCR), are now emerging as powerful tools for early pathogen diagnosis as well as pathogen diagnosis of target detectors with low microbial loads. In this study, we report a 53-year-old man who was admitted to the ICU for treatment of septic shock. The causative agent was targeted earlier as by mNGS, and the shock was corrected more quickly with targeted antibiotic medication. However, he later developed multiple septic arthritis and an extensive migratory skin soft tissue infection with persistent fever, and at one point a gram-negative bacterial infection was suspected, and the antibiotic regimen was incorrectly changed. Blood dPCR suggested that the causative organism was still lin, with no drug resistance gene detected, and the anti-infective regimen was readjusted, and the patient eventually recovered and was discharged from the hospital. We present this rare case and review related studies to validate the superiority of genetic testing technology in pathogen diagnosis, which deserves further application.
感染易于传播,但其引发的多发性化脓性关节炎以及广泛的游走性皮肤和软组织感染并不常见且治疗具有挑战性。该感染可能危及生命,死亡率为15% - 31%。早期针对性的抗生素治疗对于改善预后至关重要。然而,常规培养耗时且阳性率低,这可能导致抗生素治疗方案选择错误,使患者无法获得最佳治疗。宏基因组下一代测序(mNGS)和数字聚合酶链反应(dPCR)等基因检测技术,正成为早期病原体诊断以及低微生物载量目标病原体诊断的有力工具。在本研究中,我们报告了一名53岁因感染性休克入住重症监护病房的男性患者。通过mNGS更早地确定了病原体,针对性的抗生素用药使休克得到更快纠正。然而,他后来出现了多发性化脓性关节炎和广泛的游走性皮肤软组织感染并持续发热,曾一度怀疑革兰氏阴性菌感染,抗生素治疗方案被错误更改。血液dPCR提示病原体仍为林氏菌,未检测到耐药基因,抗感染治疗方案重新调整,患者最终康复出院。我们呈现此罕见病例并回顾相关研究,以验证基因检测技术在病原体诊断中的优越性,其值得进一步应用。