摘要
目的:分析 1 例山羊葡萄球菌所致心包炎患者的临床诊疗过程,为临床类似患者的诊断和治疗提供思路.方法与结果:患者因"反复活动后胸闷、气促 3 余年"于入院,入院后心脏彩超提示存在大量心包积液,并于第3 天予左氧氟沙星经验性抗感染治疗;患者心包积液的微生物培养始终为阴性,但宏基因二代测序结果 2 次回报山羊葡萄球菌,结合患者有骆驼奶饮用史,临床药师考虑山羊葡萄球菌为心包炎可能性较大,遂将抗感染治疗方案调整为利奈唑胺(0.6 g,q12h,静脉滴注);5 d后,患者症状明显好像,遂将利奈唑胺改为口服序贯;后续随访显示,患者恢复良好,近 1 年内未再有入院记录.结论:山羊葡萄球菌作为引起心包炎的致病菌既往几乎未见报道,对此临床应充分利用现有检测技术,并综合患者的症状和既往史,一旦明确诊断,应及时积极开展针对性治疗,以保障患者尽快康复.
Abstract
Objective:To analyze the clinical diagnosis and treatment process of one patient with pericarditis caused by Staphylococcus caprae and provide ideas for the diagnosis and treatment of similar patients in clinical practice.Methods and Results:The patient was admitted to the hospital due to chest tightness and shortness of breath after repeated activities for more than 3 years.After admission,cardiac color ultrasound showed the presence of a large amount of pericardial effusion.On the 3rd day,levofloxacin was given for empirical anti-infective treatment.The microbial culture results of the patient's pericardial effusion were always negative,but the results of the metagenomic next-generation sequencing reported Staphylococcus caprae twice.As the patient has a history of drinking camel milk,the clinical pharmacist considered that pericarditis was more probably caused by staphylococcus caprae,so the anti-infective treatment regimen was adjusted to linezolid(0.6 g,q12h,intravenous drip);5 days later,the patient's symptoms were obviously improved,so linezolid was changed to the oral sequential therapy;the follow-up visit showed that the patient recovered well and had no admission record any longer in the recent one year.Conclusion:Staphylococcus caprae has rarely been reported as a pathogen causing pericarditis in the past.For this,the existing detection techniques should be fully used and the patients'symptoms and past history should be comprehensively considered in clinical practice.Once the disease is definitely diagnosed,targeted treatment should be carried out in a timely and active manner to ensure that the patients recover as soon as possible.
维普
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