类鼻疽假单胞菌肺炎32例临床分析

Clinical analysis of 32 Pseudomonas pseudomallei pneumonia patients

目的了解类鼻疽假单胞菌肺炎的临床特点，探讨早期诊断及其治疗。方法采用回顾性分析1996年1月，2005年12月住院32例类鼻疽假单胞菌肺炎的发病、胸部X线表现、细菌的耐药性及其治疗。结果患者多见于男性，以农民发病最多，临床表现为寒战、发热、咳嗽、咳疲。胸部X线发现肺部病变32例，其中被误诊为肺结核的10例；类鼻疽假单胞菌对抗生素具有多重耐药性，但未发现对亚胺培南的耐药菌株。结论类鼻疽假单胞菌肺炎临床表现无特殊性，误诊率高，X线可早期发现肺野病变，该病确诊依靠细菌学检测。亚胺培南对类鼻疽假单胞菌敏感。应作为治疗类鼻疽假单胞菌肺炎首选用药。

Objective To understand the infectious status of Pseudomonas pseudomaUei pneumonitis for improving the method of early diagnosis and treatment. Methods The clinical symptom and signs, changes of chest X - ray the resistance of Pseudomonas pseudomaUei pneumonitis to antibiotics and results of treatment of 32 hospitalized cases during January 1996 - December 2005 were retrospective analyzed. Results Most of the infections occurred to males, the majority of them were senile peasants mainly with the manifestations of chill, fever, cough, sputum. Ten of the 32 cases of the lung lesion detected by chest X - ray were misdiagnosised as pulmonary tuberculosis. Multidrug resistance was observed, being 100 % to ampicillin, 81% to ampicillin/sulbactam, 100% to gentamicin, 94 % to amikacin, 72 % to ciprofloxacin, 78 % to levofloxacin, 64 % to trimethoprim/sulfa, 100 % to cefazolin, 72 % ceftriaxone, 22% to ceftazidime, 20% to piperacillin/tazobactam. It remains sensitive to imipenem. Conclusion There no typical clinical features are observed in patients with Pseudomonas pseudomaUei pneumonia, the misdiagotic rate is high, X - ray can detect lung lesion at early stage, an diagnosis can be confirmed by detection of the pathogen. Imipenem should be the first choice of antibiotic for treatment of patients with pseudomonas pseudomallei pneumonia.