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非妊娠期单核细胞增生李斯特菌败血症35例临床分析

Clinical characteristics of 35 non-pregnant patients with Listeria monocytogenes sepsis

摘要:

目的 通过分析非妊娠期单核细胞增生李斯特菌(李斯特菌)败血症基础疾病特点和临床特征,提高对非妊娠期李斯特菌败血症的认识.方法 回顾性分析北京协和医院2002年1月至2014年12月诊治的35例经血培养确诊的非妊娠期李斯特菌败血症的临床特点.结果 (1)35例非妊娠期李斯特菌败血症患者发病年龄(49.1±17.0)岁,男性占40%;(2)33例(94.3%)患有基础疾病/状况,其中以自身免疫病(15例,42.9%)、恶性肿瘤(12例,34.3%)常见;(3)起病中位时间为3d,常见的临床表现为发热(34/35例,97.1%)、中枢神经系统(CNS)症状(17/35例,48.6%)、胃肠道症状(13/35例,37.1%)等;(4) 14例(40.0%)经过脑脊液(CSF)检查证实合并脑膜炎,其中11例CSF培养有李斯特菌生长;(5) 19例(54.3%)初始经验性抗微生物药物选用头孢菌素.25例(71.4%)在经血培养确诊李斯特菌败血症后,抗微生物药物方案进行了调整;(6)21例(60.0%)经过治疗后好转或痊愈,8例(22.9%)因病情危重放弃治疗或出院后死亡,6例(17.1%)在住院期间死亡.结论 非妊娠期李斯特菌败血症多累及原有自身免疫病、恶性肿瘤等基础疾病的患者,临床表现为发热、CNS症状及胃肠道症状,经验性选用抗微生物药物的李斯特菌有效覆盖率低,病死率高.提示应提高临床医生的认识,对于存在导致免疫功能低下疾病的高危人群出现急性发热、临床怀疑败血症时,经验性抗菌药物应包括有效覆盖李斯特菌的青霉素类.

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abstracts:

Objective To better understand the clinical characteristics and predisposing factors in non-pregnant patients with Listeria monocytogenes (Listeria) sepsis.Methods Clinical data were collected at Peking Union Medical College Hospital between January 2002 and December 2014.A case with non-pregnant Listeria sepsis is defined as a non-pregnant person with clinically compatible illness and from whom Listeria was isolated from his/her blood culture.We define an underlying condition if a patient has been diagnosed of and/or has been treated for a concurrent baseline disease within 1 month prior to the onset of Listeria sepsis.Results A total of 35 patients were enrolled.The age of all patients was (49.1 ± 17.0) years.The male to female ratio was 2∶ 3.Most patients were combined with at least 1 underlying condition (33,94.3%),including 42.9% patients with an autoimmune disease,34.3% with malignancies.The majority (91.4%) represented an acute onset (< 1 week) with median time of 3 days.Clinical manifestations included fever (34/35,97.1%),central nervous system (CNS) symptoms (17/35,48.6%),gastrointestinal tract symptoms (13/35,37.1%).Fourteen patients had undergone lumber puncture and cerebral spinal fluid (CSF) tests,which revealed abnormalities comparable of Listeria meningitis.Listeria was isolated from CSF in 11 of 14 patients (78.6%).There were 34 patients receiving empiric antibiotics including 54.3% cephalosporins which are resistant to Listeria.Twenty five (71.4%) patients were switched to the target antimicrobials according to positive blood culture.Of the 35 patients with Listeria sepsis,21 (60.0%) recovered or were cured,however the rest (40.0%) had dismal outcome.Six patients died in hospital,8 critical patients were discharged and died after transferring to local hospitals.Conclusions Listeria sepsis is commonly associated with non-pregnant patients with compromised immune function.Clinical presentations include acute fever,CNS symptoms and gastrointestinal symptoms etc.Empiric antibiotics covering Listeria should be considered when sepsis is suspected among susceptible hosts.

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作者: 王澎 [1] 陈颖茜 [2] 王焕玲 [2] 李太生 [2] 徐英春 [1]
期刊: 《中华内科杂志》2016年55卷2期 116-120页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0578-1426.2016.02.010
发布时间: 2016-03-15
基金项目:
国家“十二五”重大新药创制科技重大专项 国家“十二五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项 国家人力资源和社会保障部2014年度留学人员科技活动项目(2014) The 12th Five-Year Major New Drug Discovery Science and Technology National Key Technologies R&D Program for the 12th Five-year Plan Grant of Chinese Ministry of Human Resources and Social Security
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