铜绿假单胞菌所致社区获得性肺炎2例报告并文献复习

Pseudomonas aeruginosa community-acquired pneumonia：two cases report and literature review

目的分析2例铜绿假单胞菌所致的社区获得性肺炎患者的临床、影像学及病原学特征。方法回顾性分析2例需人院治疗的铜绿假单胞菌肺炎患者的临床、影像学及病原学资料，复习相关文献资料。结果2例患者均为中年女性，具有相似的临床及影像学表现，以咳嗽、咳痰和发热为发病症状，病例1入院时呼吸衰竭，床旁经皮肺穿刺活检及针吸培养为铜绿假单胞菌，针对性抗感染治疗，病情进行性加重，住院9d后死亡。病例2人院时低氧血症，痰培养铜绿假单胞菌生长，抗感染治疗，病情一度好转后再加重，CT引导下经皮肺穿刺活检为炎性改变，进一步抗感染治疗后好转。2例患者发病初期胸部CT均表现为多发结节影，病例1快速进展为多发大片实变影及坏死空洞，病例2后期胸部CT主要病变逐步吸收。结论铜绿假单胞菌引起的社区获得性肺炎并不罕见，进展快速，病死率高。

Objective To describe the clinical and radiographic features of pseudomonas aeruginosa community-acquired pneumonia. Methods The clinical and radiographic data of two cases of pseudomonas aeruginosa community-acquired pneumonia were analyzed retrospectively and the related literatures were reviewed. Results These two community-acquired pneumonia patients were all female and presented similar clinical features, including cough, yellow sputum, fever, and hypoxia at admission. Pseudomonas aeruginosa was cultured in lung tissue which was taken by percutaneous transthoracic lung aspiration in case 1. The condition of case 1 got worse although the potent antibiotics were given and the patient died at 9th day after admission. Pseudomonas aeruginosa was cultured in sputum of case 2 at admission and the alternative infective agents were excluded by transthoracic lung biopsy. The initial chest computed- tomography of two patients showed multiple nodules. The nodules progressively evolved into consolidation and necrosis cavities in case 1. However the major lesions disappeared after anti-pseudomonas antibiotics treatment in case 2. Conclusions Pseudomonas aeruginosa community-acquired pneumonia, usually presenting with rapid progressive and high mortality,is not rare and should be paid more attention to.