Vartivarian S E, Papadakis K A, Palacios J A, Manning J T, Anaissie E J
University of Texas M.D. Anderson Cancer Center, Department of Medical Specialties, Houston 77030.
Ann Intern Med. 1994 Dec 15;121(12):969-73. doi: 10.7326/0003-4819-121-12-199412150-00011.
To describe the mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia in patients with cancer.
A retrospective 15-month clinical study.
Academic, referral-based cancer center.
Of 237 patients with X. maltophilia isolated from all sites during the 15-month study period, 114 patients were judged to have true X. maltophilia infections. Only patients with mucocutaneous and soft tissue infections were included in the study.
17 (15%) of the 114 patients with X. maltophilia infection had mucocutaneous and soft tissue infections: Six patients had metastatic cellulitis, 5 had primary cellulitis usually associated with catheter use, and 6 had infected mucocutaneous ulcers. The metastatic cellulitis consisted of previously undescribed multiple, hard, tender nodules with surrounding and distant cellulitis (5 patients) or ecthyma gangrenosum (1 patient). Four of these patients died of the infection. Metastatic cellulitis and mucocutaneous infections occurred in hospitalized, neutropenic patients who received broad-spectrum antibiotics (beta-lactams, quinolones), often with in vitro activity against the infecting organisms. Response usually correlated with recovery from myelosuppression and administration of trimethoprim-sulfamethoxazole with or without ticarcillin-clavulanate. Catheter removal contributed to response in the treatment of primary cellulitis.
Mucocutaneous and soft tissue infections caused by X. maltophilia are not uncommon, and X. maltophilia can cause metastatic nodular skin lesions that mimic disseminated fungal infections. It also causes serious morbidity and high mortality in patients with metastatic skin nodules and can cause superinfections in patients receiving broad-spectrum beta-lactam or quinolone antibiotics to which the organisms are susceptible when the infections develop. Catheter removal contributes to a favorable outcome in patients with catheter-associated cellulitis without bacteremia. Xanthomonas maltophilia infection should be added to the differential diagnosis of mucocutaneous or soft tissue infection in patients with cancer. Trimethoprim-sulfamethoxazole with or without ticarcillin-clavulanate is the current treatment of choice for culture-proven infections, but early empiric therapy may improve outcome.
描述嗜麦芽窄食单胞菌在癌症患者中引起的皮肤黏膜及软组织感染情况。
一项为期15个月的回顾性临床研究。
以转诊为基础的学术性癌症中心。
在为期15个月的研究期间，从所有部位分离出嗜麦芽窄食单胞菌的237例患者中，114例被判定为真正的嗜麦芽窄食单胞菌感染。本研究仅纳入有皮肤黏膜及软组织感染的患者。
114例嗜麦芽窄食单胞菌感染患者中有17例（15%）发生了皮肤黏膜及软组织感染：6例发生转移性蜂窝织炎，5例发生通常与导管使用相关的原发性蜂窝织炎，6例发生感染性皮肤黏膜溃疡。转移性蜂窝织炎表现为先前未描述的多个坚硬、触痛的结节，并伴有周围及远处蜂窝织炎（5例患者）或坏疽性脓皮病（1例患者）。其中4例患者死于感染。转移性蜂窝织炎和皮肤黏膜感染发生在住院的中性粒细胞减少患者中，这些患者接受了广谱抗生素（β-内酰胺类、喹诺酮类）治疗，这些抗生素通常对感染菌具有体外活性。治疗反应通常与骨髓抑制的恢复以及使用甲氧苄啶-磺胺甲恶唑联合或不联合替卡西林-克拉维酸有关。拔除导管有助于原发性蜂窝织炎的治疗。
嗜麦芽窄食单胞菌引起的皮肤黏膜及软组织感染并不少见，嗜麦芽窄食单胞菌可引起类似播散性真菌感染的转移性结节性皮肤病变。它还会导致转移性皮肤结节患者出现严重的发病率和高死亡率，并可在感染发生时导致接受该菌敏感的广谱β-内酰胺类或喹诺酮类抗生素治疗的患者发生二重感染。拔除导管有助于无菌血症的导管相关蜂窝织炎患者获得良好预后。嗜麦芽窄食单胞菌感染应纳入癌症患者皮肤黏膜或软组织感染的鉴别诊断。对于经培养证实的感染，目前的治疗选择是甲氧苄啶-磺胺甲恶唑联合或不联合替卡西林-克拉维酸，但早期经验性治疗可能会改善预后。
