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題名 | Klebsiella Pneumoniae Meningitis:Analysis on Clinical Features of Thirty-two Adult Patients=Klebsiella pneumoniae腦膜炎:32位病人臨床表徵之分析 |
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作者 | 盧成憲; 張文能; 吳秀善; | 書刊名 | 中華醫學雜誌 |
卷期 | 60:6 1997.12[民86.12] |
頁次 | 頁296-302 |
分類號 | 415.9313 |
關鍵詞 | 細菌性腦膜炎; 早期適當抗生素治療; 腦膜炎; 預後因素; Bacterial meningitis; Initial appropriate antimicrobial therapy; Klebsiella pneumoniae meningitis; Prognostic factors; |
語文 | 英文(English) |
中文摘要 | 背景:評估Klebsiella pneumoniae腦膜炎之成年病人其臨床表徵與藥物治療之成效。 方法:此研究分析32位成年Klebsiella pneumoniae腦膜炎之病人的臨床表徵、接受第三代cephalosporin抗生素(moxalactam, cefotaxime,ceftazidime)之治療成效、以及影響預後之因素。 結果:這些病人主要為社區感染。其中男多於女,比例為3比1。糖尿病為最常見之潛在疾患,其他還包括如肝硬化、癌症、以及尿毒症等。屬於自發性腦膜炎之病人,病程較具猛暴性,且比較容易發生菌血症、休克、甚至死亡。其死亡率高達62.5%。轉移之敗血性膿瘍相當常見,佔所有病人之19%。在抗生素的治療方面,接受早期適當抗生素治療的有21位病人,其中2人接受cefotaxime治療有1人死亡;13人接受moxalactam治療有5人死亡;6人接受ceftazidime治療有3人死亡。至於其餘11人未接受早期適當抗生素治療者,全部死亡。 結論:Klebsiella pneumoniae腦膜炎的臨床表徵是很多樣化的,且不易與其他細菌性腦膜炎做鑑別。大多數的病人經常合併有糖尿病、肝硬化、癌症、與尿毒等潛在性疾患。而影響預後的因素有:出現敗血性休克、菌血症、腦脊髓液中的乳酸濃度偏高、及早期使用適當抗生素等。雖然死亡率相當高,然而早期使用適當的抗生素可增加存活的機率。 |
英文摘要 | Background: To assess the clinical features and therapeutic outcomes of adult Klebsiella pneumoniae (KP) meningitis. Methods: Thirty-two adult patients with KP meningitis were included in this study. Their clinical features, the outcomes with the third generation cephalosporin (moxalactam, cefotaxime, ceftazidime) treatment and prognostic factors were analyzed. Results: These patients' diseases were predominantly community-acquired. Males outnumbered females (3:1). Diabetes mellitus (DM) was the most common underlying disease, followed by other debilitating diseases such as liver cirrhosis, neoplasm and end-stage renal disease (ESRD). Patients with spontaneous meningitis had a more fulminant course with a higher prevalence of bacteremia, shock and death (66%). Metastatic septic abscess was frequent (19%). Among the 21 patients who received initial appropriate antimicrobial therapy (IAAT), 2 took cefotaxime and 1 died; 13 took moxalactam of whom 5 died; and 6 took ceftazidime of whom 3 died. All of the other 11 patients who did not receive IAAT died. Conclusions: The clinical features of KP meningitis are various and indistinguishable from other form of bacteria meningitis. Most of the patients with KP meningitis are associated with underlying medical problems, such as diabetes mellitus and liver cirrhosis. Many factors, including septic shock, bacteremia, high cerebrospinal fluid lactate concentration, and IAAT, might influence the prognosis. In spite of a high mortality rate, however, IAAT is mandatory to improve the overall survival rate. |
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