静脉注射毒品者的血源性感染

Hematogenous infection in intravenous drug users

目的了解静脉吸毒者的血源性全身感染状况，以指导诊断和治疗。方法将2001年1月-2004年12月收治的18例静脉吸毒者的全身感染作回顾性分析。结果全部病例均有右心感染性心内膜炎和多发性肺脓肿，伴发肺栓塞4例、多发性脑脓肿2例、丙型肝炎3例、乙型肝炎1例。血培养结果：金黄色葡萄球菌阳性13例，其中1例同时白色念珠菌阳性；铜绿假单胞菌阳性2例；草绿色链球菌阳性3例。予青霉素、阿米卡星、头孢他啶、去甲万古霉素等治疗6周左右，除伴发脑脓肿的2例死亡、伴白色念珠菌感染1例自动出院外，余均治愈。结论静脉吸毒者血源性全身感染常见有右心感染性心内膜炎、多发性肺脓肿、肺栓塞、多发性脑脓肿、丙型肝炎、乙型肝炎等，其中脑脓肿尤具致命性。血培养阳性率高，经合理治疗后效果较好。

Objective To explore the clinical characteristics of hematogenous infection in intravenous drug users. Methods A retrospective analysis was performed in 18 cases of intravenous drug users with hematogenous infection from Jan 2001 to Dec 2004, Results Infective endocarditis of fight heart and multiple lung abbess were found in all cases. 4 cases were complicated with pulmonary infarct, 2 cases with multiple brain abbess,3 cases with infectious Hepatitis C,and one with Hepatitis B, The positive yield of blood culture were as follows： Staphylococcus aureus in 13 cases, Staphylococcus aureus and Candida albicans in one case, Pseudomonas aeruginosa in two cases, Streptococcus viridaus in three cases. After treated with penicillin, amikacin, ceftazidime,or vancomycin for about six weeks, all patients had recovered except 2 cases with brain abscess died and one case with complicated infection caused by Staphylococcus aureus and Candida albicans discharged automatically. Conchusions Hematogenous infection in intravenous drug users are usually manifested by infective endocarditis of right heart, multiple lung abscess, pulmonary infarction, multiple brain abscess, infectious hepatitis C, Hepatitis B, etc. Brain abscess is the most lethal kind of infection. The positive rate of blood culture in hematogenous infection in intravenous drug users is quite high. Correct and adequate treatment have good impact on the outcome.