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1.
《Vaccine》2020,38(3):570-577
IntroductionPediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs).MethodsIn a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped.ResultsS. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1–4.3 years] vs. median 5.6 years [IQR 3.8–8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1.ConclusionFollowing the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3. 相似文献
2.
We investigated the clinical background of patients at Shin-Kokura Hospital who showed a positive culture of pleural effusion
during the period from January 1998 through December 2002. Microorganism cultures of the pleural effusions of 127 patients
were performed in this 5-year period. Seventeen patients showed a positive microorganism culture from a pleural effusion,
and 12 of these patients (70.6%) were 60 years old or more. Ten patients were diagnosed with thoracic empyema. Thirteen patients
had an underlying disease such as malignancy (5 cases), diabetes mellitus (4 cases), etc. A purulent effusion and a high concentration
of lactic dehydrogenase (LDH) in the pleural fluid were more frequently recognized in the positive-culture group. A total
of 21 strains of microorganism were isolated from the 17 patients, including 10 strains of Gram-positive cocci, 6 strains
of Gram-negative bacilli, 3 strains of anaerobes, 1 strain of mycobacterium (Mycobacterium tuberculosis), and 1 strain of fungus. Susceptibility to antimicrobial agents was generally good for most of the microorganisms isolated.
Of the 17 patients, chest-tube drainage was performed in 13, and 6 needed a surgical operation. Twelve patients improved,
but 5 died. In this study, thoracic empyema accounted for 58.8% of the 17 cases with a positive culture of pleural effusion.
Of the 10 thoracic empyema patients, 5 patients needed surgical treatment in spite of adequate antimicrobial treatment and
chest-tube drainage. Our data indicate that thoracic empyema is still difficult to treat, and thus adequate and rapid treatment
is needed for any pleural infection. 相似文献
3.
Naoya Katsuragi Yutsuki Nakajima Yuji Shiraishi Masahiro Hashizume Nobumasa Takahashi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(8):440-442
We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with
open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous
flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity
to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side
rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous
flap is superior in that it requires a single incision and does not require an intraop-erative change of position. In addition,
the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability
of the flap even if it was divided in a previous operation. 相似文献
4.
Takaomi Hanaoka Yutsuki Nakajima Yuji Shiraishi Naoya Katsuragi Hidehiro Konno 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(2):84-87
The condition of a 51-year-old man was complicated with empyema and bronchopleural fistula (BPF) after left upper lobectomy
and thoracoplasty for pulmonary aspergillosis. On the postoperative day (POD) 12, the opened bronchial stump was directly
closed and covered with a pedicled pectoralis major muscle flap. On POD 66, an open-window thoracostomy was done, because
of empyema with Pseudomonas aeruginosa. Two years later, we could fill the empyema cavity, and close the multiple BPFs with the transposition of a modified pedicled
musculocutaneous (MC) flap and the additional thoracoplasty to gain good quality of life. Although the MC flap was a proximal
part of the latissimus dorsi muscle, which was dissected along the posterolateral incision of the first operation, it could
be successfully transplanted to cover the BPFs in the open-window. In some patients with a small open-window on the upper
anterior chest wall, the pedicled proximal latissimus dorsi MC flap may be very useful for treating persistent BPFs even after
a standard posterolateral incision. 相似文献
5.
H. Bonatti D. W Rossboth D. Nachbaur M. Fille C. Aspöck I. Hend K. Hourmont L. White H. Malnick F. J. Allerberger 《Clinical microbiology and infection》2003,9(5):380-387
Objective To investigate the epidemiology, microbiology and outcome of infections caused by Capnocytophaga spp. at a single center.
Methods We report on ten documented infectious episodes caused by Capnocytophaga observed between 1994 and 1999 at the Innsbruck University Hospital.
Results In seven of ten patients, Capnocytophaga septicemia was diagnosed during periods of neutropenia. In contrast, the remaining three patients had normal white blood cell counts when acquiring Capnocytophaga septicemia (one) and pleural empyema (two). Blood cultures containing long, slender, Gram-negative rods, which grew slowly under anaerobic conditions and lacked susceptibility to metronidazole, were subcultivated in a CO2 -enriched atmosphere (5%). Subcultivation yielded Capnocytophaga in all ten cases within 2–12 days. The patients were then placed on appropriate antibiotic therapy, with or without additional surgical intervention, and the organism was eradicated.
Conclusion Identification of Capnocytophaga facilitates appropriate, and in most cases effective, antimicrobial therapy. 相似文献
Methods We report on ten documented infectious episodes caused by Capnocytophaga observed between 1994 and 1999 at the Innsbruck University Hospital.
Results In seven of ten patients, Capnocytophaga septicemia was diagnosed during periods of neutropenia. In contrast, the remaining three patients had normal white blood cell counts when acquiring Capnocytophaga septicemia (one) and pleural empyema (two). Blood cultures containing long, slender, Gram-negative rods, which grew slowly under anaerobic conditions and lacked susceptibility to metronidazole, were subcultivated in a CO
Conclusion Identification of Capnocytophaga facilitates appropriate, and in most cases effective, antimicrobial therapy. 相似文献
6.
Adele Tessitore Miriam Patella Mauro Giuliani Thomas Theologou Stefania Freguia Eleonora Maddalena Minerva Gregor Rugel Stefano Cafarotti 《Interactive Cardiovascular and Thoracic Surgery》2021,32(3):367
We report the first surgical series of patients developing pleural empyema after severe bilateral interstitial lung disease in confirmed severe acute respiratory syndrome coronavirus 2 infection. The empyema results in a complex medical challenge that requires combination of medical therapies, mechanical ventilation and surgery. The chest drainage approach was not successful to relieve the symptomatology and to drain the excess fluid. After multidisciplinary discussion, a surgical approach was recommended. Even though decortication and pleurectomy are high-risk procedures, they must be considered as an option for pleural effusion in Coronavirus disease-positive patients. This is a life-treating condition, which can worsen the coronavirus disease manifestation and should be treated immediately to improve patient’s status and chance of recovery. 相似文献
7.
8.
目的探讨硬膜下积脓(Subdural empyema,SDE)的临床特点,为临床治疗提供借鉴。方法回顾性分析本科保守治疗的硬膜下积脓病例1例,并对已有文献报道进行综述,总结其临床、影像学表现及治疗。结果文献报道共50例患者,48例外科手术治疗,2例内科保守治疗。SDE起病急,主要临床表现为大脑镰综合征、抽搐,意识障碍。头磁共振表现:大脑镰及小脑幕下积脓呈长T1,长T2信号,FLAIR呈高信号,DWI呈高信号,积脓周围脑膜强化。治疗上主要以外科手术为主,少数病例通过合理的抗菌药物治疗也可好转。结论镰幕硬膜下积脓的临床特点是大脑镰综合征和镰幕下积脓;以外科治疗为主,内科保守治疗也是一种可行的治疗方法。 相似文献
9.
10.
目的探讨改良纤维板剥脱术对慢性结核性脓胸患者围手术期临床指标、肺功能及术后并发症的影响。方法选取慢性结核性脓胸患者140例,采用随机数字表法分为对照组(70例)和试验组(70例),分别常规纤维板剥脱术和改良纤维板剥脱术治疗。比较两组患者围手术期临床指标,术后肺活量(VC)和最大通气量(MVV)增加量及术后胸腔再次感染率等。结果两组患者手术时间、术中出血量、术后24 h引流量、引流管放置时间及住院时间等围手术期临床指标比较差异无统计学意义(P0.05);试验组患者治疗后VC和MVV增加量均高于对照组,差异有统计学意义(P0.05);两组患者术后胸腔再次感染率比较差异无统计学意义(P0.05)。结论改良纤维板剥脱术治疗慢性结核性脓胸患者可有效改善肺功能,且未对围手术期临床指标及术后并发症产生明显影响,具有临床应用价值。 相似文献