Fahmy Mark, Stewart Adam, Tey Siok-Keen, Hajkowicz Krispin
Pathology Queensland, Microbiology, James Mayne Building, Royal Brisbane and Women's Hospital, Butterfield Street, Brisbane, Queensland 4006, Australia.
Faculty of Medicine, Mayne Medical School, University of Queensland, 20 Weightman Street, Herston, Queensland 4006, Australia.
JAC Antimicrob Resist. 2024 Oct 25;6(5):dlae161. doi: 10.1093/jacamr/dlae161. eCollection 2024 Oct.
species are uncommon causes of bloodstream infections, representing a true opportunistic and multi-drug-resistant pathogen to immunocompromised or vulnerable hosts. Despite this, data are lacking regarding optimal management strategy for infections with this organism, which is associated with significant mortality and morbidity. We describe patient characteristics, management and outcomes in this case series.
All inpatients at the Royal Brisbane and Women's Hospital with a positive blood culture for spp. were identified by database query. Clinical information including medical history, source of infection, attempts at source control and outcome were collected. Laboratory data including duration of bacteraemia and antimicrobial susceptibility testing were also collected.
All patients had severe defects of innate and adaptive immunity. Targeted therapy was started promptly and efforts at source identification and control were appropriately pursued. Despite this, outcomes were generally poor. A previously unrecognized presentation of relapsing infection was described in one case, requiring long-term suppressive antimicrobials to control. One case died as a result of infection and one case was cured, but died soon after due to complications of immunosuppression.
Treatment of these organisms is challenging due to limited effective therapy, development of on treatment resistance and profound host immunocompromise. Up-front use of multiple, optimally dosed antimicrobials, attempting source control and attempting to restore host immune function all appear to be key to achieving good outcomes.
该菌属是血流感染的罕见病因，是免疫功能低下或易感染宿主真正的机会性和多重耐药病原体。尽管如此，对于这种与显著死亡率和发病率相关的病原体感染的最佳管理策略，仍缺乏相关数据。我们在本病例系列中描述患者特征、管理措施及治疗结果。
通过数据库查询确定布里斯班皇家妇女医院所有血培养 菌属呈阳性的住院患者。收集临床信息，包括病史、感染源、控制感染源的尝试及治疗结果。还收集实验室数据，包括菌血症持续时间及抗菌药敏试验结果。
所有患者均存在先天性和适应性免疫严重缺陷。及时启动了靶向治疗，并适当开展了感染源识别和控制工作。尽管如此，总体治疗结果通常较差。有一例患者出现了先前未被认识到的复发性感染表现，需要长期使用抑制性抗菌药物进行控制。有一例患者因感染死亡，一例患者感染治愈，但随后因免疫抑制并发症死亡。
由于有效治疗方法有限、治疗过程中出现耐药以及宿主免疫功能严重受损，治疗这些病原体具有挑战性。预先使用多种最佳剂量的抗菌药物、尝试控制感染源以及尝试恢复宿主免疫功能，似乎都是取得良好治疗结果的关键。
