银屑病住院患者合并败血症分析

Clinical analysis of psoriasis patients inward with septicemia

目的分析银屑病住院患者合并败血症的临床特点,做到早期诊断和治疗。方法回顾性分析2006年1月-2008年12月,在医院皮肤科住院714例银屑病患者中合并败血症的临床资料。结果 714例患者中,发生败血症7例,发生率为0.98%,其中5例为红皮病型银屑病患者,占红皮病型银屑病患者的6.85%;2例为脓疱型银屑病患者,占脓疱型银屑病患者的2.41%;从临床送检的各类标本中,共检出金黄色葡萄球菌12株,其中甲氧西林敏感金黄色葡萄球菌6株,耐甲氧西林金黄色葡萄球菌2株;凝固酶阴性葡萄球菌1株,为耐甲氧西林凝固酶阴性葡萄球菌;败血症治愈6例,治愈率85.71%。结论严重型银屑病患者合并败血症并非罕见,应引起临床皮肤科和感染科医师的重视;应监测血培养,进行脓疱的细菌培养和药物敏感性试验,首先给予经验治疗,根据药物敏感性结果再调整抗菌药物的使用,耐甲氧西林金黄色葡萄球菌感染首选万古霉素。

OBJECTIVE To describe the clinical characteristics of inward psoriasis patients with septicemia.METHODS The clinical data of psoriasis patients hospitalized in Third Hospital of Hangzhou from 2006 to 2008 were retrospectively analyzed.RESULTS Of 714 cases of patients,7 cases occurred to septicemia with the incidence rate of 0.98%,among which 5 cases were erythrodermic psoriasis,accounting for 6.85%;2 cases were pustular psoriasis,accounting for 2.41%;12 cases were detected from the submitted samples,in which there were 6 methicillin-senstive Staphylococcus aureus isolates,2 MRSA isolates;there was 1 coagulase-negative Staphylococcus which was methicillin-resistant coagulase-negative Staphylococcus;6 cases of septicemia were cured with the cure rate of 85.71%.There were 542 cases of psoriasis,including 542 cases of psoriasis vulgris,73 cases of erythrodermic psoriasis,83 cases of acute generalized pustular psoriasis and 16 cases of psoriatic arthritis,814 cases in total.（7 cases） of MRSA bacteremia were found.（5 cases） were found in erythrodermic psoriasis.（2 cases） of MRSA bacteremia were found in generalized psoriasis.No case of bacteremia were found in psoriasis vulagris and psoriatic arthritis.6 patients with septicemia were cured.CONCLUSIONS The severe psoriasis with septicemia,especially in erythrodermic and acute generalized pustular psoriasis,is common,which needs the further consideration of the dermatologists.Early bacterial culture of pustule and the drug susceptibility tests should be warranted for the first empirical therapy,the use of antibiotics should be adjusted according to the drug susceptibility test,and monitoring drug resistance is of great importance.Vancomycin is first-line therapy for the patients with methicillin-resistant Staphylococcus aureus infection.