Changing bacteriology of adult community-acquired lung abscess in Taiwan:: Klebsiella pneumoniae versus anaerobes
Changing bacteriology of adult community-acquired lung abscess in Taiwan:: Klebsiella pneumoniae versus anaerobes
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DOI：
10.1086/428574
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发表时间：
2005-04-01
影响因子：
11.8
通讯作者：
Chang, SC
中科院分区：
文献类型：
--
作者：
Wang, JL;Chen, KY;Chang, SC
背景大多数关于肺脓肿的文献集中在厌氧菌性肺脓肿，需氧革兰阴性杆菌感染较少讨论。本研究旨在探讨社区获得性肺脓肿的细菌学特征，并为社区获得性肺脓肿的经验性治疗提供依据。我们回顾并分析1995-2003年间在台湾一所大学医院连续治疗的90例经细菌学证实的社区获得性肺脓肿病例的资料。我们发现，肺脓肿的病例中有很高比例（21%）是由于肺炎克雷伯菌感染，这与以前的研究结果不同。克雷伯氏菌致肺脓肿。肺炎与基础糖尿病相关（比值比[OR]，4.3; 95%置信区间[CI]，1.0-18.4; P = .039），并与从出现症状到诊断>30天的时间呈负相关（OR，0.2; 95%CI，0.1-0.7; P = .008）。K.肺炎性肺脓肿伴菌血症（OR，9.4; 95% CI，1.1-81.9; P = 0.32），延迟退热（OR，9.2; 95% CI，1.8-47.8; P = 0.004），X线片上观察到多个空洞（OR，11.0; 95%CI，1.3-94.9; P = 0.015），与厌氧菌性肺脓肿患者相比。厌氧菌和米勒链球菌群对克林霉素和青霉素的不敏感率增加。K.肺炎已成为肺脓肿的常见病因，厌氧菌和S。Milleri菌株已经对青霉素和克林霉素产生了抗性。β-内酰胺/β-内酰胺酶抑制剂或第二代或第三代头孢菌素联合克林霉素或甲硝唑被建议作为社区获得性肺脓肿的经验性抗生素治疗。
Background. Most literature regarding lung abscess focuses on anaerobic bacterial lung abscess, and aerobic gram-negative bacillary infection is less frequently discussed. This study was conducted to investigate the bacteriology of community-acquired lung abscess and to improve the empirical therapeutic strategy for adults with community-acquired lung abscess.Methods. We reviewed and analyzed data on 90 consecutive adult cases of bacteriologically confirmed community-acquired lung abscess treated during 1995-2003 at a tertiary university hospital in Taiwan.Results. We found that a high proportion (21%) of cases of lung abscess were due to Klebsiella pneumoniae infection, which differs from the findings of previous studies. Lung abscess due to K. pneumoniae was associated with underlying diabetes mellitus (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.0-18.4; P = .039) and negatively correlated with a time from onset of symptoms to diagnosis of >30 days (OR, 0.2; 95% CI, 0.1-0.7; P = .008). A higher percentage of patients with K. pneumoniae lung abscess had concomitant bacteremia (OR, 9.4; 95% CI, 1.1-81.9; P = .32), delayed defervesence (OR, 9.2; 95% CI, 1.8-47.8; P = .004), and multiple cavities noted on radiographs (OR, 11.0; 95% CI, 1.3-94.9; P = .015), compared with patients with anaerobic bacterial lung abscess. The rate of nonsusceptibility to clindamycin and penicillin among anaerobes and Streptococcus milleri group isolates increased.Conclusion. K. pneumoniae has become a more common cause of lung abscess than before, and a high proportion of anaerobes and S. milleri strains have become resistant to penicillin and clindamycin. A beta-lactam/beta-lactamase inhibitor or second- or third-generation cephalosporin with clindamycin or metronidazole is suggested as empirical antibiotic therapy for community-acquired lung abscess.