Mu Xiang Dong, Wang Guang Fa, Que Cheng Li
Department of Respiratory Medicine, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2007 Dec 18;39(6):663-5.
To investigate the clinical characteristics, diagnosis and therapy of influenza pneumonia with staphylococcal infection. One patient in our hospital was diagnosed and the literatures on the subject were reviewed. The patient presented with high fever and dyspnea. Arterial gas analysis indicated type 1 respiratory failure. Chest X ray photographs showed bilateral infiltrations and bilateral encapsulated pleural effusions. Viral separation and culture of pharyngeal swab indicated H(3)N(2) subtype of human influenza virus. Blood, sputum and bronchoalveolar lavage fluid (BALF) cultures showed Staphylococcus aureus. Pleural effusion was complex parapneumonic pleural effusion. After the administration of anti-virus, anti-staphylococcal antibiotics and pleural cavity drainage, the patient was cured. The infection of staphylococcus aureus is a typical characteristic of influenza pneumonia, and anti-staphylococcal antibiotic therapy (with MRSA activity in MRSA endemic regions) should be initiated in hospitalized cases of influenza pneumonia. If complex parapneumonic pleural effusion or empyema complicated, we should perform pleural cavity drainage in time. The oral neuraminidase inhibitor (oseltamivir) could significantly improve prognosis.
探讨流感肺炎合并葡萄球菌感染的临床特征、诊断及治疗方法。我院收治1例患者并对该主题的文献进行回顾。患者表现为高热、呼吸困难。动脉血气分析提示Ⅰ型呼吸衰竭。胸部X线片显示双侧浸润及双侧包裹性胸腔积液。咽拭子病毒分离培养提示人甲型H(3)N(2)流感病毒。血、痰及支气管肺泡灌洗（BALF）液培养均显示金黄色葡萄球菌。胸腔积液为复杂性肺炎旁胸腔积液。给予抗病毒、抗葡萄球菌抗生素及胸腔引流治疗后，患者治愈。金黄色葡萄球菌感染是流感肺炎的典型特征，对于住院的流感肺炎病例应启动抗葡萄球菌抗生素治疗（在耐甲氧西林金黄色葡萄球菌（MRSA）流行地区具有抗MRSA活性）。若并发复杂性肺炎旁胸腔积液或脓胸，应及时进行胸腔引流。口服神经氨酸酶抑制剂（奥司他韦）可显著改善预后。
