背景希瓦氏菌属。是革兰氏阴性兼性厌氧的,氧化酶阳性,游动杆菌普遍存在,但常见于海水中,可引起机会性感染。关于Shewanella感染的危险因素的报告,其严重性,抗生素敏感性,预后有限。该报告是一名78岁的酒精性肝硬化患者,由于感染了希瓦氏杆菌而出现菌血症和脓胸。案例报告一名78岁的酒精性肝硬化男子(Child-PughB)出现高烧到我们的急诊室。他在入院前一周吃了生鱼。胸部计算机断层扫描显示右侧单侧胸腔积液,他因疑似脓胸住院。Shewanellaspp.在胸腔积液和血液培养中检测到。我们根据经验开始使用哌拉西林/他唑巴坦和万古霉素,并改用头孢曲松;使用抗生素和胸腔引流成功治疗了积液。然而,住院第53天,患者死于吸入性肺炎。在我们的文献综述中,我们提取了125例报告病例(包括我们的病例),发现男性受影响不成比例(81%);中位年龄为61.6(56-75)岁;基础疾病包括肝胆疾病(33%),恶性肿瘤(25%),和心脏病(24%);希瓦氏菌属。感染部位为皮肤和软组织(35%),呼吸系统(18%),和肝胆系统(11%);管理包括抗生素(100%),排水量(16%),清创(16%)。仅使用抗生素的存活率为74%。结论我们的案例强调了临床医生应该认识希瓦氏菌属。作为肝硬化患者脓胸和菌血症的原因,应紧急进行抗生素敏感性测试和治疗的微生物学诊断,以预防致命的败血症。
BACKGROUND Shewanella spp. are gram-negative facultative anaerobic, oxidase-positive, motile bacilli that are ubiquitous but commonly occur in seawater and can cause opportunistic infection.
Reports on the risk factors for Shewanella infection, its severity, antibiotic susceptibility, and prognosis are limited. This report is of a 78-year-old man with alcoholic cirrhosis presenting with bacteremia and
empyema due to infection with Shewanella spp.
CASE REPORT A 78-year-old man with alcoholic cirrhosis (Child-Pugh B) presented to our emergency room with a high fever. He had eaten raw fish one week prior to admission. Chest computed tomography showed a right unilateral pleural effusion, and he was hospitalized with suspected empyema. Shewanella spp. was detected in the pleural effusion and blood cultures. We initiated piperacillin/tazobactam and vancomycin empirically and switched to ceftriaxone; the effusion was successfully treated using antibiotics and pleural drainage. However, on hospitalization day 53, the patient died of aspiration pneumonia. In our literature review, we extracted 125 reported cases (including our
case) and found that men were disproportionately affected (81%); median age was 61.6 (56-75) years; underlying diseases included hepatobiliary disease (33%), malignancy (25%), and cardiac disease (24%); Shewanella spp. infection sites were skin and soft tissue (35%), respiratory system (18%), and hepatobiliary system (11%); and management included antibiotics (100%), drainage (16%), and debridement (16%). The survival rate was 74% with antibiotics alone. CONCLUSIONS Our
case highlights that clinicians should recognize Shewanella spp. as a cause of
empyema and bacteremia in patients with liver cirrhosis, and that microbiological diagnosis with antibiotic sensitivity testing and treatment should be undertaken urgently to prevent fatal sepsis.