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目的探讨裂褶菌及细菌引起急性髓性白血病造血干细胞移植患者多重感染的试验诊断和治疗方法,为临床诊断该菌感染及经验治疗提供科学依据。方法 2014年12月连续采集两次1例急性髓性白血病行造血肝细胞移植患者副鼻窦分泌物和副鼻窦清创术后坏死组织,进行真菌和细菌培养;采用法国生物梅里埃公司VITEK-2全自动微生物分析仪对细菌进行鉴定和药敏试验;采用肉汤稀释法(CLSI M38-A2)进行真菌体外药敏试验,数据采用SPSS 17.0软件进行统计分析。结果该例患者副鼻窦清创术后组织块真菌培养结果为裂褶菌,其对伏立康唑有较低的MIC值;连续两次副鼻窦分泌物和术中留取的组织块细菌培养结果均为大肠埃希菌和嗜麦芽寡养单胞菌;产ESBLs大肠埃希菌对亚胺培南、美罗培南、阿米卡星、头孢他啶等均为敏感,嗜麦芽寡养单胞菌敏感抗菌药物只有磺胺甲噁唑/甲氧苄啶。结论裂褶菌的感染少见,且难诊断,极易感染免疫低下的患者,及早进行病原学诊断,正确选用抗菌药物,是抗感染治疗成功与否的关键。
Objective To investigate the diagnosis and treatment of multiple infections caused by schizophyllum and bacteria in patients with acute myelogenous leukemia hematopoietic stem cell transplantation and to provide a scientific basis for the clinical diagnosis of the infection and experience treatment. Methods One case of acute myeloid leukemia and two cases of acute myeloid leukemia hematopoietic stem cell transplantation were collected continuously in December 2014 for the secretion of paranasal sinus and necrotizing tissue of the paranasal sinus debridement. Fungal and bacterial culture were carried out. VITEK-2 The microorganism analyzer was used to identify the bacterium and drug susceptibility test. The antibacterial susceptibility test of fungi was carried out by the broth dilution method (CLSI M38-A2). The data were analyzed by SPSS 17.0 software. Results In this case, the results of fungal culture of paraneoplastic debridement were schizophyllum, which had lower MIC value for voriconazole. The results of bacterial culture of two consecutive paranasal sinus secretions and intraoperative tissue samples were Escherichia coli and Stenotrophomonas maltophilia; ESBLs-producing Escherichia coli is sensitive to imipenem, meropenem, amikacin, ceftazidime, etc. Stenotrophomonas maltophilia sensitive antibacterial drugs only Sulfamethoxazole / trimethoprim. Conclusion Schizophyllanis infection is rare, and difficult to diagnose, easily infected with immunocompromised patients, early diagnosis of etiology, the correct choice of antimicrobial agents, the key to the success of anti-infective therapy.