Splenic abscess: another look at an old disease.
Splenic abscess: another look at an old disease.
复制标题
脾脓肿：对一种古老疾病的另一种看法。
作者：
Grace S. Phillips;Michael D. Radosevich;P. A. Lipsett
目的
探讨脾脓肿的发病率、病因、细菌学特征和治疗方法的变化。
设计
回顾性病例研究。
设置
高等教育、大学转介中心。
患者
39例脾脓肿患者。
干预措施
没有。
主要观察指标
人口统计学、体征和症状、病因、风险因素、诊断方法、细菌学特征、治疗和结局。
结果
患者平均年龄为43岁（范围，2-83岁），平均症状期为16天，出现发烧（69%）、腹痛（56%）、恶心和呕吐（38%）和脾肿大（31%）。大部分的脓肿代表转移性感染（n=19），11例继发于免疫抑制。12名患者患有人类免疫缺陷病毒病，9名患者使用静脉注射药物。在接受计算机断层扫描的患者中，所有患者的扫描结果均异常（n=33），其中28例有明确的脓肿。9个菌株为多菌型;单一微生物分离株包括革兰氏阳性菌（23%）、革兰氏阴性菌（31%）、真菌（23%）和分枝杆菌（23%）。1989年之前（1981-1988）（n=15）和1989年之后（1989-1996）（n=24）的患者在风险因素（静脉药物滥用，0% vs 47% [P= 0.02];血液恶性肿瘤，43% vs 9% [P= 0.04]）和革兰氏阳性菌株（18% vs 64%; P= 0.06）方面存在差异。患者接受了脾切除术（n=18）、开放引流术（n=4）、药物治疗（n=10）和经皮引流术（n=5），生存率分别为94%、50%、70%和100%。
结论
在1996年，脾脏肿大越来越常见。静脉药物滥用和人类免疫缺陷病毒病是重要的风险因素，在使用静脉药物的发热和腹痛患者中应考虑诊断。由于36%的细菌是多种微生物，因此抗菌剂应广泛使用，并应包括革兰氏阳性菌。
OBJECTIVE
To study the changes in the incidence, causes, bacteriologic profile, and management of a splenic abscess.
DESIGN
Retrospective case study.
SETTING
Tertiary, university referral center.
PATIENTS
Thirty-nine patients with a splenic abscess.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
Demographics, signs and symptoms, causes, risk factors, diagnostic methods, bacteriologic profile, treatment, and outcome.
RESULTS
Patients presented at a mean age of 43 years (range, 2-83 years), after a mean symptomatic period of 16 days, with fever (69%), abdominal pain (56%), nausea and vomiting (38%), and splenomegaly (31%). The majority of abscesses represented metastatic infection (n=19), and 11 were secondary to immunosuppression. Twelve patients had human immunodeficiency virus disease and 9 used intravenous drugs. In patients who underwent computed tomography, all had abnormal scans (n=33), with a well-defined abscess(es) in 28. Nine abscesses were polymicrobial; monomicrobial isolates included gram-positive organisms (23%), gram-negative organisms (31%), fungi (23%), and mycobacteria (23%). Patients presenting before 1989 (1981-1988) (n=15) and those presenting after 1989 (1989-1996) (n=24) differed in risk factors (intravenous drug abuse, 0% vs 47% [P=.02]; hematologic malignancy, 43% vs 9% [P=.04]) and gram-positive isolates (18% vs 64%; P=.06). Patients underwent splenectomy (n=18), open drainage (n=4), medical therapy (n=10), or percutaneous drainage (n=5) with respective survival rates of 94%, 50%, 70%, and 100%.
CONCLUSIONS
In 1996, splenic abscesses are increasingly common. Intravenous drug abuse and human immunodeficiency virus disease are significant risk factors, and the diagnosis should be considered in a patient with fever and abdominal pain who uses intravenous drugs. Antimicrobial agents should be broad since 36% of abscesses were polymicrobial, and should include coverage of gram-positive organisms.
重症监护室的脾脓肿。
DOI：
10.1001/archsurg.1993.01420200016003
发表时间：
1993
期刊：
Archives of surgery (Chicago, Ill. : 1960)
影响因子：
--
作者：
Ho,HS;Wisner,DH
通讯作者：
Wisner,DH