阴沟杆菌下呼吸道感染的临床和药敏测定  

The clinical manifestation and drug sensitive tests of lower respiratory tract infection by enterobacter cloacae

作　　者：罗文侗 修清玉[1,2] 陈吉泉 何国钧[3] 吴家琪 何礼贤[4] 胡必杰 沈爱娣 艾华[5] 

机构地区：[1]上海医学会肺科学会肺部感染和肺纤维化学组 [2]第二军医大学长征医院 [3]上海第一肺科医院 [4]上海医科大学中山医院 [5]上海市第六人民医院 [6]上海卢湾区中心医院

出　　处：《中华结核和呼吸杂志》1997年第4期208-211,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的总结阴沟杆菌下呼吸道感染的临床特点及该菌对常用抗生素的敏感性。方法（１）分析５８例阴沟杆菌所致肺部感染的临床资料，包括年龄、基础疾病、发病诱因、症状体征、Ｘ线表现、治疗转归等；（２）以Ｋ－Ｂ法（纸片法）或Ｅｔｅｓｔ法（ＭＩＣ纸片法）测定该菌的体外药物敏感性。结果（１）男４６例，女１２例，年龄５６±１９岁，８８％的患者有基础疾病，其中以慢性阻塞性肺疾病（ＣＯＰＤ）最常见，４１％的病例为混合感染，混合菌主要为绿脓杆菌、肺炎克雷白杆菌和真菌。症状为发热（７２％）和咳嗽、咳痰（８７％），胸部Ｘ线表现为分布于两下肺野的支气管肺炎改变，病死率为９％。（２）药敏试验提示该菌呈现多重耐药，亚胺培南、丁胺卡那、妥布霉素、环丙沙星、头孢哌酮为较敏感抗生素。结论阴沟杆菌肺部感染患者多有基础疾病，临床表现不典型，以支气管肺炎改变为主，诊断依靠病原学并结合临床及Ｘ线检查，治疗应根据药敏并联合应用抗生素。Objective To study the clinical characteristics of lowar respiratory tract infection caused by E. cloacae and to investigate the drug sensitivities of E.cloacae strains. Methods (1)Analysing the clinical deta of 58 case with lowa respiratory tract infection of enterobacter cloacae defined by a putative standard, including ages, symptoms, signs, underlying diseases, sputum culture, X ray findings and the prognosis. (2)Determining the drug sensitivities against the E. cloacae strains by K B method. Results (1)There were 46 males and 12 females, with the mean age 56±19% cases diagnosed, who had underlying diseases, most were COPD. 41% cases were mixed infections with other bacteria, most of which were P.aeruginosa and K.pneumoniae. The chief symptoms were fever (72%) and productive cough(87%).The chest X ray revealed inflammatory infiltration in lower lobes of both sides. The mortality rate was 9%. (2) The antimicrobial tests in vitro showed that these strains were multiresistant to antibiotics, but imipenem,amikacin, tobramycin, ciprofloxacin, cefoaperazone were sensitive. Conclusion The lower respiratory tract infections caused by E.cloacae showed no specific clinical manifestations. However, the mortality was high. The diagnosis should be made according to bacteriologic examination combined with clinical and X ray manifestations.Combining antibiotics therapy was recommanded according to antimicrobial sensitivity test.

关 键 词：阴沟杆菌 呼吸道感染 药敏试验 

分 类 号：R56[医药卫生—呼吸系统]