背景:硝基还原假单胞菌是一种非发酵,革兰氏阴性,通常居住在土壤中的杆状细菌,特别是被油盐水污染的土壤。据我们所知,以前没有人感染硝基还原丙酸杆菌的病例报道。这里,我们介绍了第一例有记载的菌血症患者中由硝基还原丙酸杆菌引起的胆管炎病例。
方法:一名患有晚期胰腺神经内分泌肿瘤的46岁日本男子因发热和寒战住院。入院前四天,患者出现右上腹痛。两天后,他还发烧和发冷。入院当天进行内镜逆行胰胆管造影术,患者被诊断为患有与支架功能障碍相关的胆管炎。从血液培养物中分离出革兰氏阴性棒,但尝试使用VITEK2和基质辅助激光解吸/电离飞行时间质谱(MALDI-TOFMS)与VITEKMSver鉴定细菌。4.7.1(BioMérieuxJapanCo.Ltd.,东京,日本)没有成功。最后,使用MALDI-TOFMS和MALDIBiotyper(BrukerDaltonicsCo.,Ltd.,Billerica,MA,美国)和16S核糖体RNA测序。尽管对病人进行了彻底的采访,他否认接触受污染的土壤。根据药敏结果,患者静脉注射头孢吡肟和口服环丙沙星治疗16天,取得良好的治疗效果。在第28天的门诊随访中,患者的一般情况良好。
结论:这是首例报道的由硝基还原丙酸杆菌引起的血流感染的人类胆管炎病例。本报告为临床医生提供了准确诊断硝基还原丙酸杆菌的临床表现和诊断方法的新见解。以及治疗指导。
BACKGROUND: Pseudomonas nitroreducens is a non-fermenting, gram-negative, rod-shaped bacterium commonly inhabiting soil, particularly soil contaminated with oil brine. To our knowledge, no cases of human infection with P. nitroreducens have been previously reported. Here, we present the first documented
case of cholangitis caused by P. nitroreducens in a patient with bacteremia.
METHODS: A 46-year-old Japanese man with an advanced pancreatic neuroendocrine tumor was hospitalized with fever and chills. Four days before admission, the patient developed right upper abdominal pain. Two days later, he also experienced fever and chills. Endoscopic retrograde cholangiopancreatography was performed on the day of admission, and the patient was diagnosed as having cholangitis associated with stent dysfunction. Gram-negative rods were isolated from blood cultures, but attempts to identify the bacteria using VITEK2 and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with VITEK MS ver. 4.7.1 (bioMérieux Japan Co. Ltd., Tokyo, Japan) were unsuccessful. Finally, the organism was identified as P. nitroreducens using MALDI-TOF MS with a MALDI Biotyper (Bruker Daltonics Co., Ltd., Billerica, MA, USA) and 16 S ribosomal RNA sequencing. Despite thorough interviews with the patient, he denied any exposure to contaminated soil. The patient was treated with intravenous cefepime and oral ciprofloxacin for 16 days based on susceptibility results, achieving a good therapeutic outcome. At the outpatient follow-up on day 28, the patient was in good general condition.
CONCLUSIONS: This is the first reported human
case of cholangitis with bloodstream infection caused by P. nitroreducens. This report provides clinicians with novel insights into the clinical manifestations and diagnostic methods necessary for the accurate diagnosis of P. nitroreducens, along with guidance on treatment.