罕见混合细菌感染所致股骨慢性骨髓炎1例

摘要

Objective To provide the reference of pathogenic diagnosis and clinical medication for 1 case with chronic osteomyelitis of femur.Methods Anaerobic,aerobic and microaerobic cultures and the identification of bacteria from fester and tissue specimens obtained during operation were performed by smear and microscopy. Thein vitro drug susceptibility test was performed by disk diffusion and E-test methods.Results Facultative anaerobicStreptococcus anginosus,obligate anaerobicVeillonella parvula and microaerophilic bacillusAeromonas foam were isolated from wound tissues. Thein vitro drug susceptibility test showed that they were highly sensitive to piperacillin-tazobactam,meropenem and vancomycin. Clinical medication program was as follows:preoperative and postoperative intravenous drip of piperacillin-tazobactam,medullary cavity with bone cement implantation of imipenem and vancomycin,artificial bone implantation with meropenem and vancomycin, and repair of muscle flap. The patient recovered after the above treatments.Conclusions Special attention should be paid to the patient with chronic osteomyelitis. All pathogens should be isolated,and drug susceptibility test should be performed. Individual medication program should be laid down and performed,which is a prerequisite fora thorough treatment of infection.%目的：为1例临床难治性股骨慢性骨髓炎患者提供明确的病原学诊断和临床用药依据。方法采集患者术中所取伤口脓液及组织样本，涂片镜检同时进行厌氧、需氧和微需氧培养，鉴定菌种，并采用纸片扩散法及E-test法进行体外药物敏感性试验。结果从患者伤口中分离出兼性厌氧菌咽峡炎链球菌、专性厌氧菌小韦荣球菌及微需氧菌嗜沫凝聚杆菌3种少见菌。体外药物敏感性试验结果显示，对哌拉西林-他唑巴坦、美罗培南及万古霉素的敏感性高。临床治疗方案是：术前、术后静脉滴注哌拉西林-他唑巴坦；带有亚胺培南、万古霉素的骨水泥链珠植入术；带有美罗培南、万古霉素人工骨植入术，肌瓣移植修复术。患者术后恢复良好。结论临床对慢性骨髓炎患者应给予特别关注，应该分离出所有的病原菌并进行体外药物敏感性试验，制定个体化治疗方案，这是彻底治疗感染的前提条件。