Brook I
Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Pediatrics. 1990 May;85(5):722-6.
The microbiology of empyema was studied in 72 children and adolescents whose specimens yielded bacterial growth after inoculation for aerobic and anaerobic bacteria. A total of 93 organisms, 60 aerobic or facultative and 33 anaerobic, were isolated. Aerobic bacteria was isolated in 48 (67%) patients, anaerobic bacteria in 17 (24%), and mixed aerobic and anaerobic bacteria in 7 (10%). The predominant aerobic or facultative bacteria were Haemophilus influenzae (15 isolates), Streptococcus pneumoniae (13), and Staphylococcus aureus (10). The predominant anaerobes were Bacteroides sp (15 isolates, including 7 Bacteroides fragilis group and 5 Bacteroides melaninogenicus group), anaerobic cocci (9), and Fusobacterium sp (6). beta-lactamase activity was detected in at least one isolate in 20 (37%) of the 54 tested patients. These included all 8 tested S aureus and 7 B fragilis group, 3 of 10 H influenzae, 2 of 4 B melaninogenicus group, and 1 of 2 Klebsiella pneumoniae. Most cases of S pneumoniae and H influenzae were associated with pneumonia. The recovery of anaerobic bacteria was mostly associated with the concomitant diagnosis of aspiration pneumonia, lung abscess, subdiaphragmatic abscess, and abscesses of dental or oropharyngeal origin. The data highlight the importance of anaerobic bacteria in selected cases of empyema in children and adolescents.
对72名儿童和青少年的脓胸微生物学进行了研究，这些患者的标本在接种需氧菌和厌氧菌后产生了细菌生长。共分离出93种微生物，其中60种为需氧菌或兼性菌，33种为厌氧菌。48例（67%）患者分离出需氧菌，17例（24%）分离出厌氧菌，7例（10%）分离出需氧菌和厌氧菌混合感染。主要的需氧菌或兼性菌为流感嗜血杆菌（15株）、肺炎链球菌（13株）和金黄色葡萄球菌（10株）。主要的厌氧菌为拟杆菌属（15株，包括7株脆弱拟杆菌群和5株产黑色素拟杆菌群）、厌氧球菌（9株）和梭杆菌属（6株）。在54例接受检测的患者中，20例（37%）至少有1株检测到β-内酰胺酶活性。这些包括所有8株检测的金黄色葡萄球菌和7株脆弱拟杆菌群、10株流感嗜血杆菌中的3株、4株产黑色素拟杆菌群中的2株以及2株肺炎克雷伯菌中的1株。大多数肺炎链球菌和流感嗜血杆菌病例与肺炎有关。厌氧菌的检出大多与同时诊断的吸入性肺炎、肺脓肿、膈下脓肿以及牙源性或口咽源性脓肿有关。这些数据突出了厌氧菌在儿童和青少年脓胸某些病例中的重要性。
