PDF(Pubmed)
Abstract：
BACKGROUND: Klebsiella pneumoniae invasion syndrome (KPIS) is a severe multi-site infection that is usually caused by hypervirulent Klebsiella pneumoniae. The bacteria are relatively common in Asian diabetics and can cause organ abscesses or sepsis. When patients develop intracranial infection, the prognosis is poor. After anti-infective treatment, the Klebsiella pneumoniae-induced liver and lung abscesses and pulmonary fungal infection were relieved, but the brain abscesses worsened. Such complex and severe infection cases are rarely reported. Early identification of intracranial infection, selection of antibiotics with high concentrations in cerebrospinal fluid, and active treatment of complications such as diabetes and fungal infection are of great significance for the prognosis of patients.
METHODS: A 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical ventilation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imipenem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with voriconazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up, and the patient was discharged and died in a local hospital.
CONCLUSIONS: In cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of developing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed.
METHODS: A 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical ventilation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imipenem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with voriconazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up, and the patient was discharged and died in a local hospital.
CONCLUSIONS: In cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of developing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed.
摘要：
背景：肺炎克雷伯菌入侵综合征（KPIS）是一种严重的多部位感染，通常由高毒力肺炎克雷伯菌引起。这种细菌在亚洲糖尿病患者中相对常见，可引起器官脓肿或败血症。当患者发生颅内感染时，预后较差。抗感染治疗后,肺炎克雷伯菌所致肝、肺脓肿及肺部真菌感染均得到缓解,但是脑脓肿恶化了.这种复杂和严重的感染病例很少报道。早期发现颅内感染，选择脑脊液中高浓度的抗生素，糖尿病、真菌感染等并发症的积极治疗对患者预后具有重要意义。
方法：另一医院诊断为肝脓肿的71岁患者因病情恶化转入我院。在第1天（入院日），患者接受有创机械通气，连续性肾脏替代疗法联合内毒素吸附,亚胺培南-西司他丁抗菌治疗，经皮穿刺置管引流术治疗肝脓肿。支气管肺泡灌洗液中的宏基因组下一代测序表明肺炎克雷伯菌（K。肺炎），白色念珠菌,和黄曲霉复合物，没有检测到病毒。血液和脓液培养显示肺炎克雷伯菌对哌拉西林/他唑巴坦敏感。抗感染治疗调整为哌拉西林/他唑巴坦联合伏立康唑。在第14天，头部计算机断层扫描（CT）扫描显示没有明显变化，胸部CT扫描显示双肺有多个脓肿吸收。病人仍然昏迷。拔除气管导管后，头颅磁共振成像（MRI）显示多发性脑脓肿。最后,他的家人放弃了,患者出院并在当地医院死亡。
结论：在肺炎克雷伯菌感染病例中，颅内的可能性，肝脏,肺，或其他部位感染应考虑，医生应警惕KPIS的发生。对于怀疑发生颅内感染的病人,应尽快检测和培养脑脊液，应该进行头部MRI,应早期使用脑脊液中高分布的抗生素。当患者患有糖尿病时，除了血糖控制，同时也需要警惕真菌感染.
方法：另一医院诊断为肝脓肿的71岁患者因病情恶化转入我院。在第1天（入院日），患者接受有创机械通气，连续性肾脏替代疗法联合内毒素吸附,亚胺培南-西司他丁抗菌治疗，经皮穿刺置管引流术治疗肝脓肿。支气管肺泡灌洗液中的宏基因组下一代测序表明肺炎克雷伯菌（K。肺炎），白色念珠菌,和黄曲霉复合物，没有检测到病毒。血液和脓液培养显示肺炎克雷伯菌对哌拉西林/他唑巴坦敏感。抗感染治疗调整为哌拉西林/他唑巴坦联合伏立康唑。在第14天，头部计算机断层扫描（CT）扫描显示没有明显变化，胸部CT扫描显示双肺有多个脓肿吸收。病人仍然昏迷。拔除气管导管后，头颅磁共振成像（MRI）显示多发性脑脓肿。最后,他的家人放弃了,患者出院并在当地医院死亡。
结论：在肺炎克雷伯菌感染病例中，颅内的可能性，肝脏,肺，或其他部位感染应考虑，医生应警惕KPIS的发生。对于怀疑发生颅内感染的病人,应尽快检测和培养脑脊液，应该进行头部MRI,应早期使用脑脊液中高分布的抗生素。当患者患有糖尿病时，除了血糖控制，同时也需要警惕真菌感染.
