Significant Low Mortality Rate in Patients with Community: Acquired Acinetobacter Pneumonia and Septicemia - Report of Four Cases within One Year at MMH

社區性Acinetobacter肺炎合併敗血症極低死亡率的病歷報告：馬偕醫院回顧一年的探討

楊英文(Ying-Wen Yang) ； 李昭賢(Chao-Hsien Lee) ； 呂衍達(Yen-Ta Lu) ； 吳健樑(Chien-Liang Wu) ； 陳培然(Pei-Jan Chen) ； 郭許達(Hsu-Tah Kuo)

《胸腔醫學》 18卷2期 (2003/04) Pp. 155-162

摘要

Acinetobacter 是有包膜需氧革蘭氏陰性菌，一般存於土壤及淡水中，亦常存在於皮膚，且在一般人口中7%含有此菌，它們常常造成院內感染，尤其在老年人或加護單位。然而，造成社區性的感染相當罕見，臨床上最常見的症狀包括發燒、喘、胸痛及咳嗽，其病程常是急性且死亡率相當高。
在2000年十一月至2001年十一月間，於馬偕醫院共收集到四位感染Acinetobacter造成的社區性肺炎，兩位男性，兩位女性，平均年齡70歲，血液培養均為陽性反應，且經過適當的抗生素治療；四位個案中，均有慢性阻塞性肺疾病，一位糖尿病、一位腎臟衰竭，兩位吸煙，但均無喝酒。在住院過程中，兩位產生敗血性休克及呼吸衰竭，並需於加護單位使用呼吸器治療。四位個案經過積極治療後，均能康復出院。我們發現白血球減少、酗酒及不正確診斷或抗生素治療是造成死亡率居高不下的原因。
Acinetobacter所造成的社區性肺炎，病人通常有慢性疾病，如慢性阻塞性肺疾病、糖尿病、腎臟病，並常發生於老年人。病情雖然急性且致死，但是只要及早積極性的抗生素治療，死亡率是可以降低的。一般常用的抗生素是第三代的Cephalosporin 加上Aminoglycosides為治療的基本原則。

關鍵字

社區性肺炎

並列摘要

Acinetobacter species are encapsulated aerobic Gram-negative coccobacilli ubiquitous in fresh water and soil. They are usually skin contaminants and are found in the oropharynx of up to 7% of healthy individuals, and always cause nosocomial infections in elderly patients, and in intensive care units. CAP caused by acinetobacter is quite rare. The most commonly clinical presentations are rapid onset fever, dyspnea, pleuritic chest pain, and cough. Acinetobacter-associated CAP usually results in a fulminant course with a mortality rate ranging from 40-60%.
Between November 2000 and November 2001,we reported four cases who admitted to Mackay Memorial Hospital and presented with a acinetobacter CAP and septicemia. There were two men and two women, with a mean age of 70 years. These patients had chronic pulmonary diseases, two patients were smokers, one patient had diabetes mellitus, and one patient asthma. All patients had positive blood culture results. Leukocytosis was present in three patients and lobar consolidation was the predominant radiologic pattern in all of the patients. All the patients survived following the appropriate antibiotic treatment. We also found that leukopenia, alcohol abuse, and inadequate antibiotics therapy might be associated with increased mortality.
CAP caused by acinetobacter species is often associated with underlying conditions, such as chronic pulmonary disease, cigarette smoking, diabetes mellitus, renal disease and old age. The combination of a third-generation cephalosporin, plus an aminoglycoside, may be the empirical treatment of choice.

並列關鍵字

acinetobacter ； community-acquired pneumonia