肠热症在回肠穿孔中的作用：在热带地区这是一个被夸大的问题吗？
Role of enteric fever in ileal perforations: an overstated problem in tropics?
作者信息
Capoor M R, Nair D, Chintamani M S, Khanna J, Aggarwal P, Bhatnagar D
机构信息
Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India.
出版信息
Indian J Med Microbiol. 2008 Jan-Mar;26(1):54-7. doi: 10.4103/0255-0857.38859.
PURPOSE
To determine the role of enteric fever in ileal perforations.
METHODS
A prospective cohort of 47 patients of ileal perforation was subjected to clinical examination and investigations for APACHE II scoring. Blood, ulcer edge biopsy, mesenteric lymph node and peritoneal aspirate were subjected to culture to determine the predominant aerobic bacterial isolate and its antibiogram.
RESULTS
Seven patients (14.9%) required intensive care and seven (14.9%) developed septicaemia. Mortality was 17%. Highest isolation rate was seen in ulcer edge (70.2%) followed by lymph node (66%) culture. The bacterial spectrum was Escherichia coli (23.4%), Enterococcus faecalis (21.3%), Salmonella enterica serovar Typhi (6.3%), Salmonella enterica serovar Paratyphi A (4.2%), etc.
CONCLUSIONS
Enteric fever organisms are not the predominant causative agents of ileal perforations. Culture of ulcer edge biopsy, lymph node is crucial for aetiological diagnosis. The use of APACHE II triaging and prescription of antimicrobials based on the local pattern of susceptibility profile of the aetiological agent is recommended.
目的
确定伤寒热在回肠穿孔中的作用。
方法
对47例回肠穿孔患者进行前瞻性队列研究，进行临床检查和急性生理与慢性健康状况评分系统（APACHE II）评分调查。采集血液、溃疡边缘活检组织、肠系膜淋巴结和腹腔穿刺液进行培养，以确定主要的需氧菌分离株及其抗菌谱。
结果
7例患者（14.9%）需要重症监护，7例（14.9%）发生败血症。死亡率为17%。溃疡边缘培养的分离率最高（70.2%），其次是淋巴结培养（66%）。细菌谱包括大肠埃希菌（23.4%）、粪肠球菌（21.3%）、伤寒沙门菌（6.3%）、甲型副伤寒沙门菌（4.2%）等。
结论
伤寒热病原体不是回肠穿孔的主要致病因素。溃疡边缘活检组织和淋巴结培养对于病因诊断至关重要。建议使用APACHE II分诊，并根据病原体的当地药敏谱模式开具抗菌药物。
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