- 期刊
＂Bacteroides Thetaiotaomicron＂ Sepsis in an Elderly Patient with Ischemic Bowel Disease
西塔類桿菌引起老年人缺血性腸壞死及敗血症
摘要
西塔類桿菌是革蘭氏陰性的厭氧細菌，屬於類桿菌屬。它總是被當作是腸胃道、口腔、陰道和呼吸道的正常菌屬，因而它與人類的感染是很少被報導。一位八十四歲的婦人表現漸進性的下腹痛和發燒已有一天，腹部X光顯現腸阻塞，腹部電腦斷層顯示小腸壁肥厚並在遠端迴腸壁內有氣體及混濁的腹水，此現象和缺血性腸壞死有一致的表現。由於頑固性的代謝性酸中毒，所以給予持續性洗腎治療和更換抗生素成imipenem和metronidazole。同時，兩套血液培養是長出西塔類桿菌。由於她的家屬拒絕開刀建議，最後她在住院第四天死亡。我們提出一例西塔類桿菌引起老年人缺血性腸壞死的死亡病例，此病例顯示西塔類桿菌也是有可能造成腹內感染。
並列摘要
Bacteroides thetaiotaomicron, a gram-negative anaerobic bacterium, belongs to the genus Bacteroides. lt is always considered as the normal floras of the gastrointestinal tract, oral cavity, vagina, and respiratory tract, however, it associated human infections are rarely reported. An 84-year-old woman presented with progressive lower abdominal pain and fever for one day. Abdominal X ray revealed ileus. Computed tomography of abdomen disclosed diffuse small bowel wall thickening with intramural air at distal ileum and ascites, which was consistent with ischemic bowel disease. Antibiotic was switched to imipenem and metronidazole, and continuous renal replacement therapy was applied for refractory metabolic acidosis. In the meanwhile, two sets of bacterial culture of blood yielded B. thetaiotaomicron. Her family refused surgical intervention, and finally, she died on hospital day 4. In conclusion, we report a fatal case of B. thetaiotaomicron bacteremia developed in an elderly patient with ischemic bowel disease. This case expands the spectrum of infection caused by B. thetaiotaomlcron, and raises the possibility of B. thetaiotaomicron as one of the causes of intra-abdominal infections.