Meng Li-Na, Li Gang
Department of Intensive Care Unit, Peking University International Hospital, Beijing, China.
Front Immunol. 2024 Dec 10;15:1364391. doi: 10.3389/fimmu.2024.1364391. eCollection 2024.
The escalating demographic shift towards an aging population and the widespread occurrence of immunological diseases have contributed to an elevation in the frequency of community-acquired infections. Notably, among these infections, community-acquired bloodstream infections (CABSI) stand out due to their significant lethality. Detailed medical history inquiries, assessment of underlying immune status, detection of the source of infection, and initial precise identification and treatment of the infectious agents can improve the prognosis of CABSI.
In this paper, two incidences of severe CABSI with insidious onset and rapid progression are described. Both patients had compromised basic immunity: one developed the infection following unhygienic dietary practices, and the other after repeated enemas leading to intestinal damage. Blood genomic sequencing revealed the presence of and in the respective cases, with the origin of the infection traced back to the gastrointestinal tract. Both patients experienced positive outcomes following targeted antibiotic therapy, fluid resuscitation, support for organ function, and surgical interventions. Nevertheless, one patient manifested dry gangrene in the extremities during the course of treatment, potentially associated with the administration of vasoconstrictor drugs, considering the compromised baseline vascular conditions.
Clinicians are advised to expeditiously uncover concealed medical histories and potential sources of infection in patients, thoroughly investigate the origin of the infection, and initiate early genomic testing to ascertain the specific nature of the infection. This proactive approach aims to facilitate precise treatment strategies and, consequently, enhance the overall prognosis.
人口向老龄化的不断转变以及免疫性疾病的广泛发生，导致社区获得性感染的频率上升。值得注意的是，在这些感染中，社区获得性血流感染（CABSI）因其显著的致死性而突出。详细询问病史、评估潜在免疫状态、检测感染源以及对感染病原体进行初步精确鉴定和治疗，可以改善CABSI的预后。
本文描述了两例严重CABSI病例，起病隐匿且进展迅速。两名患者的基础免疫力均受损：一名患者因饮食不卫生而感染，另一名患者因反复灌肠导致肠道损伤后感染。血液基因组测序分别在两例病例中发现了[具体内容未给出]，感染源追溯至胃肠道。两名患者在接受针对性抗生素治疗、液体复苏、器官功能支持和手术干预后均取得了良好的治疗效果。然而，考虑到基线血管状况受损，一名患者在治疗过程中出现了肢体干性坏疽，可能与血管收缩药物的使用有关。
建议临床医生迅速发现患者隐藏的病史和潜在感染源，深入调查感染源，并尽早开展基因组检测以确定感染的具体性质。这种积极主动的方法旨在促进精确的治疗策略，从而改善总体预后。
