军团菌肺炎合并耐甲氧西林表皮葡萄球菌败血症1例报告并文献复习

Legionella pneumonia accompanied with methicillin resistant staphyloccocus epidermidis septicemia:a case report and review of the literature

目的探讨军团菌肺炎合并耐甲氧西林表皮葡萄球菌(MRSE)败血症的临床诊断和治疗。方法报道1例军团菌肺炎合并MRSE败血症患者的诊治过程。结合文献复习,对军团军肺炎合并MRSE败血症的诊断和治疗进行讨论。结果骨髓穿刺培养报告为MRSE。用万古霉素3天后体温逐渐下降,9天后体温正常。3月5日至20日两次血清军团菌抗体检测显示LB1:8和LL1:8滴度升高4倍。结论军团菌肺炎合并MRSE败血症的临床确诊需结合军团菌肺炎诊断标准和血(骨髓)培养证实MRSE阳性,治疗须联合万古霉素和新大环内酯类或氟喹诺酮类抗菌药物。

Objective To explore the clinical diagnosis and treatment of legionella pneumonia accompanied with methicillin resistant staphylococcus epidermidis （MRSE） septicemia. Mathods A case of legionella pneumonia accompanied with MRSEsepticemia was reported. The literalures were reviewed, and diagnosis and treatment of legionella pneumonia were discussed. Results Laboratory reported that the myelogenous culture grew MRSE. We started using vancomycin Temperature of the patient was decreased gradually after using vancomycin for3 days, and was normal after vancomycin therapy for 9 days. From March 5 to 20, serologictests made twice shown that titer of antibody to legionella pneumophilia serogroup LB and LL was increased from 1：8 to 1：32. Conclusion The clinical diagnosis of legionella pneumonia accompanied with MRSE septicemia should be made according to diagnostic criteria of legionella pneumonia combination with MRSE grew comfirmed by blood （or myelogenous） culture. The treatment need to combine vancomycin with new macrolides or fluoroquinolone.