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因培养延迟导致治疗困难的胸膜感染:1例病例报告及28例文献综述

pleural infection that was difficult to treat due to delayed culture: A case report and literature review of 28 cases.

作者信息

Shimoda Masafumi, Tanaka Yoshiaki, Kokutou Hiroyuki, Furuuchi Koji, Osawa Takeshi, Morimoto Kozo, Yano Ryozo, Yoshimori Kozo, Ohta Ken

机构信息

Respiratory Disease Center, Fukujuji Hospital, Japan Anti-tuberculosis Association, Kiyose City, Tokyo, Japan.

出版信息

Respir Med Case Rep. 2021 Oct 21;34:101530. doi: 10.1016/j.rmcr.2021.101530. eCollection 2021.

Abstract

An eighty-three-year-old man suffered from cough, right chest pain, and progressive dyspnea for sixteen days. He had hypoxemia, high white blood cells and C-reactive protein, and moderate right-sided pleural effusion on radiographic imaging. A pleural fluid examination revealed exudate. He was diagnosed with pleural infection and treated with intravenous ampicillin/sulbactam. On the second day of hospitalization, the treatment was changed to levofloxacin and clindamycin due to drug eruption. He improved gradually and was prescribed only oral levofloxacin on the eighteenth day of hospitalization. However, improvements in inflammation and imaging findings were poor. resistant to fluoroquinolones was cultured from a pleural effusion sample on the twenty-sixth day of hospitalization. The treatment was changed to oral clindamycin, and his medical condition subsequently improved. We reviewed twenty-eight patients with pleural infection and thirty-eight patients with other pleural infection phenotypes from our hospital and published case reports. pleural infection is a long-term process and results in a large amount of pleural effusion compared to other pleural infection phenotypes. These results might be related to the fact that is a slow-growing organism.

摘要

一名83岁男性出现咳嗽、右胸痛及进行性呼吸困难16天。他存在低氧血症、白细胞及C反应蛋白升高,影像学检查显示右侧中等量胸腔积液。胸腔积液检查提示渗出液。他被诊断为胸腔感染,并接受静脉注射氨苄西林/舒巴坦治疗。住院第二天,因药物疹将治疗改为左氧氟沙星和克林霉素。他逐渐好转,住院第18天仅予口服左氧氟沙星。然而,炎症及影像学表现改善不佳。住院第26天,胸腔积液样本培养出对氟喹诺酮耐药菌。治疗改为口服克林霉素,其病情随后改善。我们回顾了我院28例胸腔感染患者及38例其他胸腔感染表型患者以及已发表的病例报告。与其他胸腔感染表型相比,胸腔感染是一个长期过程且会导致大量胸腔积液。这些结果可能与[具体病原体]是一种生长缓慢的微生物这一事实有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ef3/8551650/8e479728c070/gr1.jpg

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