肺炎克雷伯菌感染致脓毒血症及多发脓肿诊治探讨

Diagnosis and Treatment of Sepsis and Multiple Abscess Caused by Klebsiella Pneumoniae Infection

目的探讨肺炎克雷伯菌(klebsiella pneumoniae,KP)致脓毒血症及全身多发脓肿的诊治要点。方法回顾性分析KP感染致脓毒血症及全身多发脓肿1例的临床资料,并复习相关文献。结果本例因口干、多饮、多尿伴消瘦4月余入院。既往患2型糖尿病,予降糖治疗,血糖控制欠佳。入院后患者突发高热,查血白细胞升高,予抗感染治疗,后出现气促及视物模糊,行B超、CT、血常规等医技检查及血培养可见KP生长,明确诊断为脓毒血症并肝、肺、肾及眼多器官脓肿,予抗感染及对症支持治疗,症状好转出院。后失访。结论 KP致脓毒血症并多发脓肿临床症状不典型,早期诊断并及时合理使用抗生素是避免误诊误治的关键。

Objective To investigate the diagnosis and treatment of sepsis and systemic multiple abscess caused by Klebsiella pneumoniae(KP).Methods We retrospectively analyzed clinical data of a patient with sepsis and systemic multiple abscess due to KP infection,and reviewed the relevant literature.Results This patient with a history of diabetes,was hospitalized due to dry mouth,polydipsia,polyuria and weight loss for over 4 months.The blood sugar had a suboptimal response after hypoglycemic treatment.After hospitalization,the patient suffered from sudden fever attributed to increased leukocytes.Following anti-infection treatment,he experienced shortness of breath and blurred vision.An ultrasound exam,CT and routine blood tests,as well as blood culture indicating KP growth revealed a clear diagnosis:KP-induced sepsis and multiple organ abscess,including the liver,lung,kidney and eye.After anti-infection and supportive treatment,symptoms were relieved,and the patient was discharged from hospital.However,the patient was lost to follow-up.Conclusion Clinical symptoms of KP-induced sepsis and multiple abscess are atypical,therefore,timely and rational use of antibiotics as well as early diagnosis and treatment are the key to avoid misdiagnosis.