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目的了解艰难梭菌菌血症的临床特征。方法对1例艰难梭菌菌血症患者的临床表现、实验室检查结果、治疗及转归进行分析,并结合相关文献复习艰难梭菌菌血症的特征。结果该例39岁男性患者脑外伤后出现发热,血培养中检测出艰难梭菌,其毒素A、B及ニ元毒素基因均阳性。使用头孢曲松-他唑巴坦和去甲万古霉素联合抗感染治疗14d后,患者康复出院。通过文献复习发现艰难梭菌菌血症患者大多数有慢性肝炎、肝硬化等消化道基础疾病,主要症状为发热、腹痛、血便、恶心呕吐等。使用过甲硝唑或万古霉素治疗的患者死亡2例(2/13)未使用的患者死亡4例(4/6)。结论艰难梭菌菌血症患者大多数都有慢性基础疾病、消化道疾病或有手术及外伤史。早期应用万古霉素和甲硝唑治疗,其预后相对较好。
Objective To understand the clinical features of Clostridium difficile bacteremia. Methods The clinical manifestations, laboratory findings, treatment and prognosis of one patient with Clostridium difficile bacteremia were analyzed. The characteristics of Clostridium difficile bacteremia were reviewed in combination with related literatures. Results The 39-year-old male patient developed fever after traumatic brain injury. Clostridium difficile was detected in blood cultures, and the toxins A, B and B genes were positive. Patients were discharged after 14 days of treatment with ceftriaxone-tazobactam and norvancomycin in combination with anti-infectives. Through the literature review found that most patients with Clostridium difficile bacteremia have chronic hepatitis, cirrhosis and other gastrointestinal diseases, the main symptoms of fever, abdominal pain, bloody stool, nausea and vomiting. Two patients died of metronidazole or vancomycin (2/13), and 4 patients (4/6) died of unused patients. Conclusion Most patients with Clostridium difficile bacteremia have chronic underlying diseases, gastrointestinal diseases or history of surgery and trauma. Early application of vancomycin and metronidazole treatment, the prognosis is relatively good.