Schelenz Silke, Bramham Kate, Goldsmith David
Microbiology Department, Norfolk and Norwich University Hospital, Bowthorpe Road, Norwich, NR2 3TX, UK.
Joint Bone Spine. 2007 May;74(3):275-8. doi: 10.1016/j.jbspin.2006.08.007. Epub 2007 Mar 15.
Septic arthritis due to Klebsiella species is a rare but serious infection that may destroy a joint and cause serious immobility. This is a report of two immunocompromised adult patients presenting with acute septic arthritis due to extended spectrum beta lactamase producing Klebsiella pneumoniae. The infection was treated successfully with a course of meropenem and amikacin in combination with early arthroscopic washout of the joint. Little information has been published on the management of this infection. We are therefore presenting a systematic literature review summarizing risk factors, clinical presentation, laboratory diagnosis, treatment regimens and outcome of this condition.
On the basis of our study, we recommend an early diagnostic arthrocentesis of the joint for Gram stain microscopy, culture and antibiotic sensitivity testing to guide the appropriate use of antibiotics. In cases of hospital acquired infections where drug resistant Gram negative bacteria are suspected or prevalent, broad-spectrum antibiotics such as meropenem plus or minus amikacin may be given as the empirical treatment until the sensitivities are confirmed. In addition, adequate surgical joint lavage should be considered as the mainstay of treatment.
肺炎克雷伯菌引起的化脓性关节炎是一种罕见但严重的感染，可能会破坏关节并导致严重的活动障碍。本文报告了两名免疫功能低下的成年患者，他们因产超广谱β-内酰胺酶的肺炎克雷伯菌而出现急性化脓性关节炎。通过美罗培南和阿米卡星联合早期关节镜冲洗治疗，感染得到成功治愈。关于这种感染的治疗，相关信息报道较少。因此，我们进行了一项系统的文献综述，总结了该疾病的危险因素、临床表现、实验室诊断、治疗方案及预后。
基于我们的研究，我们建议对关节进行早期诊断性关节穿刺，以进行革兰氏染色显微镜检查、培养及抗生素敏感性测试，从而指导抗生素的合理使用。在怀疑或存在耐多药革兰氏阴性菌的医院获得性感染病例中，在敏感性结果确认之前，可给予美罗培南加或减阿米卡星等广谱抗生素作为经验性治疗。此外，充分的手术关节灌洗应被视为治疗的主要手段。
