Bayer A S, Nelson S C, Galpin J E, Chow A W, Guze L B
Am J Med. 1975 Dec;59(6):851-6. doi: 10.1016/0002-9343(75)90471-4.
Clostridia are rare causes of pleuropulmonary infections in the absence of penetrating chest injuries; only 10 previous cases have been reported from civilian practice. An additional case of a rapidly progressive, necrotizing pneumonia and empyema is reported. Clostridial pneumonia is more likely to occur in patients with underlying pleuropulmonary disease. Unlike clostridial myonecrosis, it is rarely associated with toxemia; its mortality rate is comparable to that of nonclostridial pleuropulmonary infections. Appropriate antimicrobial therapy with surgical drainage of the empyema is the treatment of choice. Among the cases reviewed, an iatrogenic cause of infection involving an invasive procedure into the pleural cavity could be identified in seven of 11 cases. Aspiration of oropharyngeal contents was the likely route of infection in three other cases. In the remaining case, bacteremic seeding of the pleural cavity was the most probable mode of infection.
在没有胸部穿透伤的情况下，梭菌是胸膜肺部感染的罕见病因；此前仅有10例来自普通临床实践的病例报道。本文报告了1例快速进展的坏死性肺炎合并脓胸的病例。梭菌性肺炎更易发生于有潜在胸膜肺部疾病的患者。与梭菌性肌坏死不同，它很少与毒血症相关；其死亡率与非梭菌性胸膜肺部感染相当。选择合适的抗菌治疗并对脓胸进行手术引流是首选的治疗方法。在所回顾的病例中，11例中有7例可确定感染的医源性病因涉及侵入性胸腔操作。另外3例中，口咽内容物吸入可能是感染途径。在其余病例中，胸膜腔的菌血症播散是最可能的感染方式。
