Noncatheter-related bacteraemia due to Chryseobacterium indologenes in an immunocompetent patient

Chryseobacterium indologenes belongs to a group of nonfermentative Gram-negative bacilli and is an uncommon human pathogen. It causes severe infections such as septicaemia and ventilator-associated pneumonia in immunocompromised patients or after prolonged hospitalisation. We report a case of a noncatheter-related bacteraemia in a 22-year-old immunocompetent female whose blood culture showed the growth of C. indologenes, identified by Vitek GNI system (bioMerieux, France). The patient responded to treatment with ciprofloxacin. The pathogenicity and virulence factors of C. indologenes remain unclear. This case indicates that C. indologenes might cause symptomatic disease in immunocompetent persons with otherwise no associated underlying risk factors.     

医院感染脑膜炎败血性金黄杆菌的分布及耐药性分析

目的了解我院脑膜炎败血性金黄杆菌的分布和耐药性。方法统计分析我院近5年来分离的73株脑膜炎败血性金黄杆菌的耐药情况；用双纸片协同试验筛选金属β-内酰胺酶。结果脑膜炎败血性金黄杆菌产金属β-内酰胺酶为37．0％，主要分布在重症监护（ICU）病房，哌拉西林／他唑巴坦、万古霉素和利福平耐药率较低，分别为45．2％、40．6％和28．5％。结论脑膜炎败血性金黄杆菌表现为多重耐药，临床医师应根据药敏试验合理选择抗菌药物。     

不常见非发酵菌对常见抗菌药物敏感性分析

目的了解临床分离的伯克霍尔德菌属、金色杆菌属、产碱杆菌属等不常见非发酵菌的耐药性。方法从2004年~2006年临床各种标本中分离到的不常见革兰阴性杆菌用V ITEK-2全自动微生物分析仪进行检测鉴定,药物敏感性试验采用纸片扩散法。数据分析采用WHONET 5.4软件进行处理、统计和分析。结果两年中中山大学第一附属医院共收集患者首次分离株118株,其中伯克霍尔德菌属47株(其中洋葱伯克霍尔德菌41株,皮氏伯克霍尔德菌6株),金色杆菌属44株(其中脑膜脓毒性金黄杆菌17株,产吲哚金黄杆菌23株),产碱杆菌属27株(其中粪产碱杆菌13株,木糖氧化无色杆菌12株)。96.6%的菌株来源于痰标本。对伯克霍尔德菌属有较强体外抗菌活性的依次为:复方磺胺甲口恶唑(87.2%)、哌拉西林/三唑巴坦(87.0%)、左氧氟沙星(85.3%)、头孢吡肟(83.0%)、头孢他啶(78.6%)和头孢哌酮/舒巴坦(78.3%)。对金色杆菌属有较强体外抗菌活性以复方磺胺甲口恶唑(87.5%)最高。对产碱杆菌属敏感性较高的药物分别为头孢哌酮/舒巴坦(84.6%)和美罗培南(77.8%)。结论头孢哌酮/舒巴坦对三种非发酵菌都有较高体外抗菌活性。常规实验室鉴定方法易将三种菌相互混淆,甚至与氧化酶阴性的非发酵菌混淆,这可能是造成各地报道药敏结果差异的原因之一。     

重症监护病房内脑膜脓毒金黄杆菌医院感染肺炎临床及耐药分析

目的对发生在重症监护病房(ICU)内脑膜脓毒金黄杆菌,医院感染肺炎的临床特征和细菌的耐药性进行分析,以便今后能更好地预防和治疗该细菌所致的感染. 方法对我院重症监护病房2001年1月～2004年6月出现的,42例脑膜脓毒金黄杆菌医院感染肺炎患者的资料作回顾性分析. 结果 42例患者均有严重的基础疾病,与感染相关的因素包括住院和入住ICU的天数、人工气道、机械通气、深静脉置管、应用广谱抗菌药物;脑膜脓毒金黄杆菌仅对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、磺胺和替卡西林/克拉维酸较为敏感,敏感率在76.2%～52.2%之间. 结论缩短住院和入住ICU时间、尽量减少有创操作、合理应用抗菌药物是减少感染发生的重要措施;脑膜脓毒金黄杆菌是多重耐药菌,危重患者感染后,治疗相当棘手.     

临床分离黄杆菌金属β内酰胺酶及其基因型研究

目的了解临床分离黄杆菌（Chryseobacterium spp）耐药特性和金属β内酰胺酶（metallo-β-lactamase，MBL）的产酶率及其基因型。方法采用琼脂稀释法检测50株黄杆菌对18种抗生素的MIC，三纸片增效法、改良三维试验法进行MBL表型检测，PCR检测及序列分析确定MBL的基因型。接合试验检测耐药基因是否具有可转移性，等电聚焦电泳（IEF）测定β内酰胺酶等电点（pI）。结果50株黄杆菌对碳青霉烯类、氨基糖甙类及多种β内酰胺抗生素呈高度耐药，亚胺培南、美罗培南的耐药率均达82．0％，但利福平和喹诺酮类药物表现出很强的抗菌活性。表型检测33株细菌产MBL，产酶率为66．0％。MBL基因型分析结果，20株产吲哚黄杆菌携带bla IND，其中bla IND-1型9株、bla IND-2型10株、bla IND-LIKE型1株。14株脑膜炎败血黄杆菌中检出17种MBL基因，分别为blaB1 2株、blaB2 5株、blaB3 4株、blaB114株、bla GOB-1bla 1株；GOB-101株。接合试验均为阴性，质粒DNA未检出MBL基因。携带bla IND-1^-的菌株（C-5）经IEF、MBL表型检测及β内酰胺酶初筛均为阴性。结论黄杆菌具有严重的多重耐药现象，同时具有很高的MBL检出率。bla B、bla GOB和bla IND可能位于黄杆菌染色体上，不能通过细菌质粒等可移动基因元件发生不同菌株和菌株间传播。bla IND-1可能存在蛋白质的不表达或低水平表达。     

A severe form of Chryseobacterium indologenes pneumonia in an immunocompetent patient

We report a case of severe pneumonia due to Chryseobacterium indologenes in an immunocompetent patient. Chryseobacterium indologenes (formerly Flavobacterium indologenes) are saprophytic Gram-negative rods widely distributed in damp environment. Many sites of infection were described in the literature. These infections are always severe sometimes associated to multiple organ failure. The evolution is usually favorable with antibiotic treatment. Bacteria characteristically grow as yellow-pigmented colonies. They are naturally resistant to many antimicrobial agents. They are usually susceptible to piperacillin(DCI) alone or combined with tazobactam(DCI), ceftazidime(DCI), cefepime(DCI), fluoroquinolones(DCI), rifampin(DCI) and cotrimoxazole(DCI), but the in vitro susceptibility to these antibiotics should be systematically tested. Nevertheless, the optimum antibiotic treatment for Chryseobacterium-related infections remains to be established. In the case we report, the diagnosis was made according to the results of bronchial sample bacterial culture. This case report underlines the need for specific management of patients infected with this species.     

2005-2008年脑膜脓毒金黄杆菌医院感染及qacE△1基因的监测

目的 了解脑膜脓毒金黄杆菌临床感染特点和耐药现状.方法 对2005-2008年从各类临床标本中分离到的脑膜脓毒金黄杆菌株统一用K-B法进行体外药敏试验,并对患者资料进行统计分析;应用PCR基因扩增技术检测耐消毒剂qacE△1.结果 分离菌株最多的病区是ICU,占43.7％,其次为呼吸科,占22.9％;药敏试验结果表明,该菌对阿米卡星、庆大霉素和环丙沙星、左氧氟沙星、亚胺培南、美罗培南耐药率＞80.0％,对磺胺甲噁唑/甲氧苄啶、头孢他啶、头孢吡肟耐药率＞70.0％,对哌拉西林/他唑巴坦耐药率最低,为16.7％,其次为头孢哌酮/舒巴坦47.9％;消毒剂基因qacE△1阳性率为8.3％.结论 脑膜脓毒金黄杆菌对多种抗菌药物具有较高的耐药性,临床抗感染治疗应以分离菌株的体外抗菌药物敏感性为依据.     

Waterborne Elizabethkingia meningoseptica in Adult Critical Care

Elizabethkingia meningoseptica is an infrequent colonizer of the respiratory tract; its pathogenicity is uncertain. In the context of a 22-month outbreak of E. meningoseptica acquisition affecting 30 patients in a London, UK, critical care unit (3% attack rate) we derived a measure of attributable morbidity and determined whether E. meningoseptica is an emerging nosocomial pathogen. We found monomicrobial E. meningoseptica acquisition (n = 13) to have an attributable morbidity rate of 54% (systemic inflammatory response syndrome >2, rising C-reactive protein, new radiographic changes), suggesting that E. meningoseptica is a pathogen. Epidemiologic and molecular evidence showed acquisition was water-source–associated in critical care but identified numerous other E. meningoseptica strains, indicating more widespread distribution than previously considered. Analysis of changes in gram-negative speciation rates across a wider London hospital network suggests this outbreak, and possibly other recently reported outbreaks, might reflect improved diagnostics and that E. meningoseptica thus is a pseudo-emerging pathogen.     

Elizabethkingia meningoseptica: Emergent bacteria causing pneumonia in a critically ill child

Elizabethkingia meningoseptica is an unusual, highly resistant, gram‐ negative bacillus. While E. meningoseptica–associated meningitis outbreaks have been well‐documented in hospital neonatal wards and among immunocompromised adults, reports describing this microorganism in critically ill children are scarce. The purpose of this report was to describe a case of a 3 year‐old girl who developed pneumonia caused by E. meningoseptica in the setting of previous use of broad‐spectrum antibiotics and to review the pediatric literature regarding this pathogen.     

Chryseobacterium indologenes in four patients with leukemia

Chryseobacterium indologenes is a rare opportunistic pathogen causing hospital‐acquired infection. We present 4 patients with leukemia associated with C. indologenes infection. Two of the patients, undergoing peripheral blood allogeneic hematopoietic stem cell transplantation (alloHSCT) from human leukocyte antigen‐identical sibling donors, died of pneumonia caused by C. indologenes with or without Pseudomonas aeruginosa. Blood infection with C. indologenes was found in the other 2 patients during chemotherapy, 1 of which was a central venous catheter‐related bloodstream infection. Both patients were cured with or without the sensitive antibiotic. Three of these 4 isolates were susceptible to trimethoprim‐sulfamethoxazole only in vitro. Although C. indologenes has a weak toxicity, it can be lethal for the super‐immunocompromised patients, such as those treated with alloHSCT.