屎肠球菌所致肺脓肿一例并文献复习

目的 提高对屎肠球菌所致肺脓肿的认识,提高其诊断及治疗水平.方法 回顾性分析解放军总医院呼吸科1例经病理及肺组织细菌学培养确诊的屎肠球菌性肺脓肿病例并进行相关文献复习.结果 患者男,60岁,因"反复咳嗽、咳痰6个月余,加重伴痰中带血3个月余"于2008年1月30日入院,入院前曾怀疑"肺栓寒"、"肺癌"等,在外院2次CT引导下经皮肺穿刺组织活检考虑为"肺炎",但经多种抗菌药物治疗效果差,肺部病变进展伴空洞形成.入院后在CT引导下经皮肺穿刺组织活检及细菌学培养,确诊为屎肠球菌肺脓肿,根据药敏试验结果给予万古霉素、替考拉宁及利奈唑胺治疗后好转.到目前为止,国内外能检索到确诊为肠球菌性肺炎或肺脓肿的个案报道共13例,其中屎肠球菌性肺脓肿3例.结论 屎肠球菌性肺脓肿极少见,确诊需要病理及肺组织细菌学培养;根据药敏试验结果应用抗菌药物可取得较好疗效.

Enterococcus faecium lung abscess: one case report and literature review

Objective To study the diagnosis and treatment of enterococcus faecium lung abscess. Methods A retrospective analysis of one case of Enterococcus faecium lung abscess and literature review was conducted. Results This patient suffered from cough and sputum over 6 months and complicated with hemoptysis over 3 months. Pulmonary embolism and lung cancer were suspected initially. After 2 times of CT-guided pereutancous transthoracic needle aspiration biopsy the diagnosis of pneumonia was made in other hospitals. However, the consolidation in the lung progressed and cavity appeared although antibiotic therapy was conducted. After admission to our hospital, CT-guided percutancous transthoracic needle aspiration biopsy was made and the lung tissue was sent for bacterial culture. Enterococcus faecium was cultured and it was susceptible to vancomycin, teicoplanin and linezolid. The disease improved significantly after treatment with these 3 antibiotics in turn. In addition, 13 cases of enterococcus pneumonia or lung abscess were reviewed, including 3 cases of enterococeus faecium lung abscess. Conclusions Enterococcus fnecium is rarely a pathogen for lung abscess. The diagnosis of enterococcus faecium lung abscess could be confirmed by lung biopsy and bacterial culture of lung tissue which could also provide the susceptibility of antibiotics and guide the antibiotic therapy.