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Radiographic Findings of Nosocomial Pneumonia Caused by Pandrug-Resistant Pseudomonas aeruginosa

全抗藥性綠膿桿菌肺炎之胸部X光表現

摘要


背景:全抗藥性綠膿桿菌在本院有逐漸盛行的現象,這篇研究希望能發現全抗藥性綠膿桿菌的胸部X光表現的特色。 方法:我們根據實驗室從2003年一月到十二月,痰液培養出全抗藥性綠膿桿菌的紀錄,蒐集符合肺炎診斷的病人臨床的相關資料,特別是針對胸腔影像方面的特色進行分析。 結果:全部總共蒐集了17位病人,其中7人為單純只有全抗藥性綠濃桿菌肺炎,其餘10人為多種細菌感染合併全抗藥性綠膿桿菌肺炎。病人的平均年齡為65歲,其中男性占大多數(77%)。病人中94%正使用呼吸器,59%有發燒,88%有白血球過多症。胸部X光的表現以兩側肺部都有浸潤(71%)占大多數,其中瀰漫性(59%)比局部病灶常見。其他表現包括肋膜積液(59%),斑狀變化(53%),融合性實質化(41%),實質化合併支氣管空氣徵象(18%),間質性(6%),和氣胸(6%),但無開洞或膿胸表現。所有病人的28天死亡率是12%,住院中死亡率是59%。 結論:全抗藥性綠膿桿菌肺炎的胸部X光表現差異性很大,而且沒有專一性,但主要以兩側肺部分佈為主,且無開洞或膿胸。大部分的病人為呼吸器造成之肺炎,這些病人有很高的住院中死亡率。

並列摘要


Background: The emergence of pandrug-resistant Pseudomonas aeruginosa (PDRPA) was noted in a tertiary hospital in Taiwan. In following, this study was designed to evaluate the radiographic features of nosocomial PDRPA pneumonia, as seen in this hospital. Patients and Methods: The clinical history of hospitalized patients with sputum cultures positive for PDRPA treated at National Taiwan University Hospital from January to December 2003 were reviewed. Patients who fulfilled the diagnostic criteria of pneumonia were included, and their clinical as well as radiographic features were analyzed. Results: A total of 17 patients, including 7 with pure PDRPA isolates and 10 with mixed isolates, were evaluated. Their mean age was 65 years, and male patients predominated (77%). Of this group, 94% were receiving mechanical ventilation upon diagnosis of PDRPA pneumonia. Only 59% of the patients had fever, despite the fact that 88% had leukocytosis. Bilateral involvement was most common (71%) and the diffuse pattern (59%) was more frequent than focal involvement. Other frequent abnormalities included pleural effusion (59%), patchy air-space disease (53%), confluent air-space opacification (41%), consolidation with air bronchograms (18%), an interstitial pattern (6%), and pneumothorax (6%). No cavity or empyema was found. Although the 28-day mortality rate was 12%, the in-hospital mortality rate was 59%. Conclusions: The radiographic presentations of nosocomial PDRPA pneumonia varied widely and were largely non-specific, but they tended to be bilaterally distributed and did not form cavities orempyema. Ventilator-associated pneumonia accounted for most of the cases. Patients with nosocomial PDRPA pneumonia have a high in-hospital mortality rate.

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