The Clinical Significance of Bacteroides fragilis Bacteremia in Gastrointestinal Diseases

胃腸疾病中脆弱類桿菌菌血症的臨床意義

張智翔(Tze-Sian Chan) ； 陳俊男(Chun-Nan Chen) ； 吳明順(Min-Shung Wu) ； 冷國楓(Kuo-Feng Len) ； 陳永發(Yun-Fa Chen) ； 姚振榮(Chen-Ron Yao) ； 李文生(Wen-Sen Lee)粟發滿(Fat-Moon Suk) ； 連吉時(Gi-Shih Lien)

《臺灣消化醫學雜誌》 30卷1期 (2013/03) Pp. 11-19

https://doi.org/10.6557/GJT.201303_30(1).0002

摘要

背景：厭氧菌感染是一種在臨床上較為罕見但死亡率高的感染症。本研究針對厭氧菌中之脆弱類桿菌所造成的菌血症進行其臨床表現之分析。方法：本研究自2003年1月至2008年12月在北部某醫學中心以脆弱類桿菌菌血症表現之病人進行回溯性之研究。研究分析項目包括臨床表現、相關疾病、死亡之危險因子、和腸胃道腫瘤之相關連性及病人治療結果。結果：本院在這六年共有61235套陽性之血液培養，其中脆弱類桿菌陽性菌血症的案例共只有49套。脆弱類桿菌菌血症每年的平均發生率約為0.08%。平均發生年齡為72±1.6歲，其中最年輕及最年長之病人分別為45至90歲。其中死亡之人數為14人，占所有呈現脆弱類桿菌陽性案例之29%。最常見的細菌入口為腸胃道及肝膽道（33/49，67%）。消化道腫瘤是和脆弱類桿菌菌血症最有相關的疾病種類，共有9例，其中全數為惡性腫瘤。其他如軟組織之感染、肝膽系統之感染症及腸胃道之破裂也常為造成脆弱類桿菌菌血症的原因。病人的死亡似乎和有否腹水之形成及貧血有關。非脆弱類桿菌所造成之厭氧菌菌血症的個案共為82人，其中以呼吸道感染為主要原因。病人的死亡似乎和性別及有否腹水之形成有關。結論：本院的統計發現脆弱類桿菌菌血症之病人的死亡率是很高的。腸胃道之病灶是細菌選擇進入身體最常發生的地方。我們認為脆弱類桿菌菌血症的病人值得針對腸胃道有否腫瘤進行進一步的檢查。

關鍵字

貧血 ； 腹水 ； 菌血症 ； 脆弱類桿菌 ； 癌症

並列摘要

Background: Infections due to anaerobic pathogens are rare in clinical practice but carry a high mortality rate. This study aimed to explore the clinical manifestations of patients with Bacteroides fragilis (B. fragilis) bacteremia. Methods: We retrospectively studied patients with B. fragilis bacteremia from January 2003 to December 2008 in a teaching hospital in Northern Taiwan. Patients with positive blood culture due to B. fragilis were collected. We investigated the clinical manifestations, underlying diseases, risk factors of mortality, association with gastrointestinal tumors, and outcomes. Results: We identified 49 patients with B. fragilis bacteremia out of 61235 positive blood culture sets in 6 years. The overall incidence of B. fragilis bacteremia was 0.08% per year. The average age was 72 ± 1.6 years (range: 45-90 years). Of the 49 patients, 14 patients demised, yielding an overall mortality of 29%. The main portals of bacterial entry were the gastrointestinal and hepatobiliary tracts (33/49, 67%). The most common underlying gastrointestinal disease associated with B. fragilis bacteremia was the 9 gastrointestinal tumors, which were all malignant. The main predisposing risk factors included soft tissue infection, biliary tract infection, and gastrointestinal organ perforation. Fatality correlated with the presence of ascites (9.7% in the survivors group vs. 50% in the demised group, p = 0.005) and anemia (45.2% in the survivors group vs. 78.6% in the demised group, P = 0.037). Conclusions: B. fragilis bacteremia has a high mortality rate, and B. fragilis often gets access from gastrointestinal lesions, e.g. gastrointestinal tumors. When B. fragilis bacteremia is detected clinically, it warrants investigation for possible gastrointestinal malignancies.

並列關鍵字

anemia ； ascites ； bacteremia ； bacteroides fragilis ； cancer