异基因造血干细胞移植术后合并脊柱嗜麦芽窄食单胞菌感染1例

林丽; 叶佩佩; 李双月; 于朱若涵

doi:10.16766/j.cnki.issn.1674-4152.003656

异基因造血干细胞移植术后合并脊柱嗜麦芽窄食单胞菌感染1例

doi: 10.16766/j.cnki.issn.1674-4152.003656

宁波大学附属人民医院血液科，浙江宁波 315000

基金项目:

浙江省医药卫生科技计划项目 2024KY1602

详细信息

通讯作者:
林丽，E-mail：31326728@qq.com

中图分类号: R379.9
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出版历程
- 收稿日期: 2024-03-20
- 网络出版日期: 2024-11-19

A case report of spinal infection caused by Stenotrophomonas maltophilia following allogeneic hematopoietic stem cell transplantation

Department of Hematology, the Affiliated People ' s Hospital of Ningbo University, Ningbo, Zhejiang 315000, China

摘要

摘要: 本文报道1例急性髓系白血病(acute myeloid leukemia，AML)异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation，allo-HSCT)术后患者，以反复腰痛为临床表现，经过多次腰椎穿刺活检及病原学检查，最终通过宏基因组二代测序(metagenomic next-generation sequencing, mNGS)确诊为脊柱嗜麦芽窄食单胞菌感染，经复方磺胺甲噁唑片联合左氧氟沙星治疗获得成功。
- 造血干细胞移植 /
- 嗜麦芽窄食单胞菌 /
- 脊柱感染
Abstract: We report a case of acute myeloid leukemia (AML) that developed after allogeneic hematopoietic stem cell transplantation (allo-HSCT), initially presenting as recurrent low back pain. The patient was finally diagnosed with a spinal Stenotrophomonas maltophilia infection by metagenomic next-generation sequencing (mNGS) and was successfully treated with a combination of compound sulfamethoxazole tablets and levofloxacin.
- Allogeneic hematopoietic stem cell transplantation /
- Stenotrophomonas maltophilia /
- Spinal infection

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图 1 allo-HSCT术后合并脊柱嗜麦芽窄食单胞菌感染患者腰椎MR(4月7日)

注：L_3~4椎体骨髓水肿，椎体终板炎首先考虑；腰骶部皮下软组织水肿。

Figure 1. Lumbar spine MR in patients with spinal stenotrophomonas maltophilia infection after allo-HSCT surgery (April 7th)

下载: 全尺寸图片幻灯片

图 2 allo-HSCT术后合并脊柱嗜麦芽窄食单胞菌感染患者腰椎MR检查(8月29日)

注：L_3~4椎体感染性病变，结核伴椎旁脓肿？其他病变待排；L₅、S₁椎体终板炎；腰椎附件旁软组织肿胀。

Figure 2. Lumbar spine MR in patients with spinal stenotrophomonas maltophilia infection after allo-HSCT surgery(August 29th)

下载: 全尺寸图片幻灯片

图 3 allo-HSCT术后合并脊柱嗜麦芽窄食单胞菌感染患者腰椎MR(6月28日)

注：L_1~5椎体及附件、椎旁韧带多发信号异常，累及多个椎体终板，感染性病变？对照前片病变范围增大；腰骶部皮下软组织水肿。

Figure 3. Lumbar spine MR in patients with spinal stenotrophomonas maltophilia infection after allo-HSCT surgery (June 28th)

下载: 全尺寸图片幻灯片

参考文献(17)

[1]	BITTENCOURT M C, CIUREA S O. Recent advances in allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia[J]. Biol Blood Marrow Transplant, 2020, 26(9): e215-e221. doi: 10.1016/j.bbmt.2020.06.007
[2]	胡付品, 郭燕, 朱德妹, 等. 2018年CHINET中国细菌耐药性监测[J]. 中国感染与化疗杂志, 2020, 20(1): 1-10. HU F P, GUO Y, ZHU D M, et al. 2018 CHINET bacterial resistance monitoring in China[J]. Chinese Journal of Infection and Chemotherapy, 2020, 20(1): 1-10.
[3]	BROOKE J S. Advances in the microbiology of Stenotrophomonas maltophilia[J]. Clin Microbiol Rev, 2021, 34(3): e0003019. DOI: 10.1128/CMR.00030-19.
[4]	ISOM C M, FORT B, ANDERSON G G. Evaluating metabolic pathways and biofilm formation in Stenotrophomonas maltophilia[J]. J Bacteriol, 2022, 204(1): e398. DOI: 10.1128/jb.00398-21.
[5]	SCHEICH S, KOENIG R, WILKE A C, et al. Stenotrophomonas maltophilia colonization during allogeneic hematopoietic stem cell transplantation is associated with impaired survival[J]. PLoS One, 2018, 13(7): e0201169. DOI: 10.1371/journal.pone.0201169.
[6]	SABURI M, OSHIMA K, TAKANO K, et al. Risk factors and outcome of Stenotrophomonas maltophilia infection after allogeneic hematopoietic stem cell transplantation: JSTCT, Transplant Complications Working Group[J]. Ann Hematol, 2023, 102(9): 2507-2516. doi: 10.1007/s00277-023-05320-4
[7]	ABAD C L, PHUOC V, KAPOOR P, et al. Bone and joint infections among hematopoietic stem cell transplant recipients[J]. J Bone Jt Infect, 2019, 4(5): 209-215. doi: 10.7150/jbji.38120
[8]	TSANTES A G, PAPADOPOULOS D V, VRIONI G, et al. Spinal infections: an update[J]. Microorganisms, 2020, 8(4): 476. doi: 10.3390/microorganisms8040476
[9]	ALJAWADI A, JAHANGIR N, JEELANI A, et al. Management of Pyogenic Spinal Infection, review of literature[J]. J Orthop, 2019, 16(6): 508-512. doi: 10.1016/j.jor.2019.08.014
[10]	SATO K, YAMADA K, YOKOSUKA K, et al. Pyogenic spondylitis: clinical features, diagnosis and treatment[J]. Kurume Med J, 2018, 65(3): 83-89. doi: 10.2739/kurumemedj.MS653001
[11]	邓亚开, 陈伟南. 胫腓骨开放性骨折后感染患者降钙素原与C反应蛋白水平变化及其诊断意义[J]. 中华全科医学, 2020, 18(10): 1663-1666. doi: 10.16766/j.cnki.issn.1674-4152.001587 DENG Y K, CHEN W N. The detection and diagnosis value of PCT and CRP in patients with open fracture of tibia and fibula[J]. Chinese Journal of General Practice, 2020, 18(10): 1663-1666. doi: 10.16766/j.cnki.issn.1674-4152.001587
[12]	石仕元, 胡胜平, 费骏, 等. 宏基因组二代测序技术在脊柱非结核感染性疾病诊断中的应用价值[J]. 中华骨科杂志, 2022, 42(15): 961-967. SHI S Y, HU S P, FEI J, et al. Application value of metagenomic next generation sequencing in the diagnosis of non-tuberculous spinal infection[J]. Chinese Journal of Orthopaedics, 2022, 42(15): 961-967.
[13]	GIL-GIL T, MARTÍNEZ J L, BLANCO P. Mechanisms of antimicrobial resistance in Stenotrophomonas maltophilia: a review of current knowledge[J]. Expert Rev Anti Infect Ther, 2020, 18(4): 335-347. doi: 10.1080/14787210.2020.1730178
[14]	GALES A C, SEIFERT H, GUR D, et al. Antimicrobial susceptibility of Acinetobacter calcoaceticus: Acinetobacter baumannii complex and Stenotrophomonas maltophilia clinical isolates: results from the SENTRY antimicrobial surveillance program (1997-2016)[J]. Open Forum Infect Dis, 2019, 6(Suppl_1): S34-S46.
[15]	GAJDÁCS M, URBÁN E. Prevalence and antibiotic resistance of Stenotrophomonas maltophilia in respiratory tract samples: a 10-year epidemiological snapshot[J]. Health Serv Res Manag Epidemiol, 2019, 6: 1-9.
[16]	TAMMA P D, AITKEN S L, BONOMO R A, et al. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections[J]. Clin Infect Dis, 2023, 22: 1-53.
[17]	GIAMPAOLINI N, BERDINI M, ROTINI M, et al. Non-specific spondylodiscitis: a new perspective for surgical treatment[J]. Eur Spine J, 2022, 31(2): 461-472. doi: 10.1007/s00586-021-07072-z