Table 1_Liver abscess and septic shock due to Clostridium perfringens infection: a case report and literature review.docx

Clostridium perfringens causes liver abscesses with a low incidence, rapid progression, and high mortality. Within a few days or even within 24 h, patients may progress from a liver abscess to sepsis, multi-organ failure, and potentially death. Diagnosing Clostridium perfringens infection by routine microbiological testing (CMT) is often challenging. Here, we present a patient with negative blood cultures who was ultimately diagnosed with a liver abscess due to Clostridium perfringens infection, confirmed by metagenomic next-generation sequencing (mNGS). The patient initially presented with fever only, and his blood cultures were negative. Subsequently, the patient’s condition progressed rapidly, and he developed signs of septic shock. Immediately after admission to the ICU, he received combined anti-infective therapy with meropenem and tigecycline, as well as urgent ultrasound-guided puncture and drainage. Blood mNGS identified Clostridium perfringens and a variety of anaerobic bacteria, confirming that the pathogen had been covered by empirical antibiotics. Continued anti-infective therapy and drainage improved the patient’s symptoms, and he was eventually discharged from the hospital. Clinicians should be highly suspicious of liver abscesses with negative blood cultures. The use of mNGS to identify the pathogen, appropriate antibiotics, and abscess aspiration and drainage are key to patient survival.

产气荚膜梭菌（Clostridium perfringens）引发的肝脓肿虽发病率较低，却具有病情进展迅速、病死率极高的特点。患者可在数天乃至24小时内，从肝脓肿进展为脓毒症、多器官功能衰竭，甚至死亡。常规微生物检测（routine microbiological testing, CMT）诊断产气荚膜梭菌感染往往颇具挑战。本文报告1例血培养呈阴性的患者，最终通过宏基因组二代测序（metagenomic next-generation sequencing, mNGS）确诊为产气荚膜梭菌感染所致肝脓肿。该患者初始仅表现为发热，血培养结果为阴性。随后病情快速进展，出现感染性休克征象。入住重症监护室（Intensive Care Unit, ICU）后即刻接受美罗培南（meropenem）与替加环素（tigecycline）联合抗感染治疗，并紧急实施超声引导下穿刺引流术。血液宏基因组二代测序检出产气荚膜梭菌及多种厌氧菌，证实经验性抗生素已覆盖该病原体。后续经持续抗感染治疗与引流后，患者症状好转，最终出院。临床医师应对血培养阴性的肝脓肿保持高度警惕。借助宏基因组二代测序明确病原体、选用适宜抗生素及实施脓肿穿刺引流，是挽救患者生命的关键。