The bacteriology of pleural infection by genetic and standard methods and its mortality significance
The bacteriology of pleural infection by genetic and standard methods and its mortality significance
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DOI：
10.1164/rccm.200601-074oc
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发表时间：
2006-10-01
影响因子：
24.7
通讯作者：
Davies, Robert J. O.
中科院分区：
文献类型：
--
作者：
Maskell, Nick A.;Batt, Sarah;Davies, Robert J. O.
背景：胸膜感染的抗生素选择是不确定的，因为其细菌学描述很少。方法：对434例胸膜感染患者的胸膜液进行标准培养，并通过细菌16S核糖体RNA基因扩增和测序进行细菌筛选。结果：社区获得性感染约50%为链球菌感染，20%为厌氧菌感染。大约60%的医院获得性感染包括经常对抗生素耐药的细菌（耐甲氧西林金黄色葡萄球菌，25%，肠杆菌科，18%；假单胞菌，5%，肠球菌，12%）。医院获得性感染（医院，17/36[47%]；社区，53/304[17%]；相对危险度为4.24；95%可信区间为2.07-8.69;p < 0.00001; chi(2), 1 df = 17.47）、革兰氏阴性（110/22[45%]）、金黄色葡萄球菌（115/34[44%]）或混合有氧感染（113/28[46%]）的死亡率高于链球菌感染（23/137[17%]）和含厌氧菌感染（10/49 [20%];p < 0.00001, chi(2), 4 df = 23.35）。结论：胸膜感染在细菌学上不同于肺炎，需要不同的治疗方法。社区获得性感染的抗生素应治疗好氧和厌氧菌。医院获得性、革兰氏阴性金黄色葡萄球菌和混合性需氧感染的死亡率很高。
Background: Antibiotic choices for pleural infection are uncertain as its bacteriology is poorly described.Methods: Pleural fluid from 434 pleural infections underwent standard culture and a screen for bacteria by amplification and sequencing of bacterial 16S ribosomal RNA gene.Results: Approximately 50% of community-acquired infections were streptococcal, and 20% included anaerobic bacteria. Approximately 60% of hospital-acquired infections included bacteria frequently resistant to antibiotics (methicillin-resistant Staphylococcus aureus, 25%, Enterobacteriaceae, 18%; Pseudomonas spp., 5%, enterococci, 12%). Mortality was increased in hospital-acquired infection (hospital, 17/36 [47%]; community, 53/304 [17%]; relative risk, 4.24; 95% confidence interval, 2.07-8.69; p < 0.00001; chi(2), 1 df = 17.47) and in gram-negative (110/22 [45%]), S. aureus (115/34 [44%]), or mixed aerobic infections (113/28 [46%]), compared with streptococcal infection (23/137 [17%]) and infection including anaerobic bacteria (10/49 [20%]; p < 0.00001, chi(2), 4 df = 23.35).Conclusion: Pleural infection differs bacteriologically from pneumonia and requires different treatment. Antibiotics for community-acquired infection should treat aerobic and anaerobic bacteria. Hospital-acquired, gram-negative S. aureus and mixed aerobic infections have a high mortality rate.