首都医科大学学报 ›› 2017, Vol. 38 ›› Issue (5): 744-749.doi: 10.3969/j.issn.1006-7795.2017.05.021

• 临床研究 • 上一篇    下一篇

成人侵袭性沙门菌属感染23例临床分析

郭益群, 王鹏, 杨春霞, 谷丽   

  1. 首都医科大学附属北京朝阳医院感染和临床微生物科, 北京 100020
  • 收稿日期:2017-03-06 出版日期:2017-09-21 发布日期:2017-10-18
  • 通讯作者: 谷丽 E-mail:guli2013227@foxmail.com

Clinical analysis of 23 adult cases of invasive salmonellosis

Guo Yiqun, Wang Peng, Yang Chunxia, Gu Li   

  1. Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2017-03-06 Online:2017-09-21 Published:2017-10-18

摘要: 目的 分析总结侵袭性沙门菌属感染病例的临床特点及沙门菌属的抗生素药物敏感性,为临床诊治提供依据。方法 回顾性分析首都医科大学附属北京朝阳医院2010年3月至2016年10月住院的23例成人侵袭性沙门菌感染病例的临床表现、实验室检查、治疗预后及抗生素敏感性。结果 23例病人中位年龄62(19,83)岁,男女比例为17:6,合并基础疾病/情况的有18例(78.26%)。12例形成肠外局部感染病人的中位年龄为67.5岁,其中91.67%合并基础病,4例为感染性动脉瘤。临床表现:高热(T ≥ 39℃)者20例(86.96%),寒战者21例(91.3%),腹泻7例(30.43%),全血白细胞中位数9.22(2.53,26.33)×109/L,白细胞<10×109/L者13例(56.5%),嗜酸性粒细胞比例≤ 0.005者18例(78.26%)。住院病人中19例临床治愈或好转出院,2例转院治疗,死亡2例。环丙沙星和氨苄西林敏感性较其他6种抗生素低(分别为37.5%和34.78%),且差异具有统计学意义,环丙沙星中介的占到56.25%(9/16)。结论 侵袭性沙门菌感染好发于中老年及合并基础疾病者,临床表现为多种疾病形式,多有寒战高热,少有腹泻,超半数全血白细胞不升高且大部分病人嗜酸性粒细胞减少。动脉粥样硬化病人合并沙门菌血流感染时要警惕感染性动脉瘤的形成。选择抗生素时避免氨苄西林及环丙沙星,可以考虑三代头孢及左氧氟沙星。

关键词: 沙门菌属, 侵袭性沙门菌属感染, 感染性动脉瘤, 环丙沙星

Abstract: Objective To analyze the clinical characteristics of invasive salmonellosis for better clinical diagnosis and management. Methods A retrospective investigation of the clinical manifestation, laboratory test, clinical course and outcome,antimicrobial susceptibility of Salmonella clinical isolates of 23 cases with invasive Salmonellosis were tested between March 2010 and October 2016 in Beijing Chaoyang Hospital. Results Among the 23 invasive cases in this paper,17 patients were male patients,the median age was 62 years;Most of them(78.26%) had the basic disease/conditions. The median age of 12 cases with local infection(including 4 cases of infectious aneurysms)was 67.5 years, and 91.67% had underlying diseases. Most patients presented with high fever(86.96%)and chill (91.3%),the intestinal symptom like diarrhea was infrequent(30.43%).The median count of blood leukocytes was 9.22(2.53,26.33)×109/L,13 cases (56.5%) of white blood cells (WBC)<10×109/L, and eosinophil% less than 0.5% were 78.26%.Nineteen cases were cured or improved, 2 cases transferred to other hospitals,and 2 cases died. The sensitivity of Salmonella to ciprofloxacin and ampicillin were lower (37.5%, 34.78%respectively)(P<0.05).Intermediate to ciprofloxacin accounted for 56.25%.Conclusion The incidence of invasive salmonellosis was associated with advanced age and presence of underlying diseases,which can take the form of a variety of diseases. It was characterized by high fever, chills, rare diarrhea. In the half of the cases, whole blood leukocytes did not increase and acidophilic granulocyte reduced. Clinicians should keep in mind that infected aortic aneurysm is highly possible in patients with atherosclerosis when blood bacteria cultivation result of Salmonella. Antibiotics are chosen to avoid ampicillin and ciprofloxacin, which can be considered for three-generation cephalospore and levofloxacin.

Key words: Salmonella, invasive salmonellosis, infectious aneurysm, ciprofloxacin

中图分类号: