目的 报道一例罕见的由唾液乳杆菌（Lactobacillus Salivarius）引起的胃恶性肿瘤肝转移患者菌血症病例，讨论唾液乳杆菌引起人类机会性感染的风险与诊治。方法 回顾分析该患者术后血流感染的诊断与治疗过程，比较分析VITEK 2 Compact全自动细菌分析仪和安图生物Autof ms1000全自动微生物质谱检测系统，以及16S rRNA测序进行菌株的鉴定过程。使用湖南长沙天地人生物科技公司药敏试验卡（TDR ANA-AST）进行药敏试验，为临床提供用药指导。结果 患者术后采集的血培养在2-3天内先后有3瓶血培养报阳，直接涂片革兰染色镜检查见革兰阳性杆菌。VITEK 2 Compact全自动细菌分析仪鉴定结果为嗜酸乳杆菌（Lactobacillus acidophillus），安图生物Autof ms1000全自动微生物质谱检测系统和16S rRNA测序鉴定结果均为唾液乳杆菌（Lactobacillus Salivarius）。使用亚胺培南进行抗感染治疗后，复查血培养均为阴性。结论 从上海市东方医院南院收治的一例胃恶性肿瘤肝转移患者术后血培养中分离出一株唾液乳杆菌（L. salivarius），经过药敏试验为临床合理用药提供了指导。
Abstract
Objective To report a rare case of bacteremia caused by Lactobacillus salivarius in gastric cancer patient with liver metastasis, and to discuss the risk of opportunistic infection caused by Lactobacillus salivarius. Methods The diagnosis and treatment of bloodstream infection in this patient were retrospectively analyzed. VITEK 2 compact automatic bacterial analyzer and Antu autof ms1000 automatic microbial mass spectrometry detection system were compared, and 16S rRNA sequencing was also used to identify the strains. TDR ANA-AST was used for drug sensitivity test to provide clinical medication guidance. Results Three bottles of blood culture were positive in 2-3 days after operation. Gram positive bacilli were detected by direct smear and colonoscopy. The strains was identified as Lactobacillus acidophilus by VITEK 2 compact. Antu biological Autof ms1000 automatic microbial mass spectrometry detection system and 16S rRNA sequencing were all identified the strains as Lactobacillus salivarius. After using imipenem for anti infection treatment, the blood culture was negative. Conclusion Lactobacillus salivarius was isolated from the blood culture of a gastric cancer patient with liver metastasis in Shanghai East Hospital. The drug sensitivity test provides guidance for clinical drug use.
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