Clinical Analysis Of 164 Cases Of Septicemia Associated With Lung Infections

Objective:To analyse the basic diseases,clinical manifestations,imaging datas,diagnosis and treatment of 164 cases of bloodstream infection involving the lungs,and summarize the clinical characteristics,to provide the reference of the diagnosis and treatment for clinical bloodstream infections involving the lungs.Methods:The basic diseases,clinical manifestations,imging datas,etiology informations,treatment and prognosis of 164 cases of bloodstream infection involving the lungs confirmed by blood culture and chest CT in our hospital between January 2010 and December 2014 was analyzed retrospectively,and discussed combining with the domestic and international literatures.Results:116 cases were male and 48 females,male to female ratio was 2.4:1,age between 18-88 years old,mean age was 51 ± 17 years old.43.9%are hospital-acquired,56.1%are community-acquired.1.basic disease:89%patients with basic diseases,mainly hematological disease,type 2 diabetes mellitus patients,cerebrovascular accident.66%have high-risk factors for bloodstream infections such as invasive procedures,long-term use of hormones or immunosuppressive agents.2.Clinical manifestations:98.8%patients with fever and high fever mainly respiratory symptoms of cough,sputum,chest pain,hemoptysis,dyspnea,cough and sputum are the most common symptoms.3.White blood cells increased in 108 cases(65.9%),the neutrophil percentage increased in 109 cases.4.pathogenic examination and sensitivity:174 were cultured pathogens,including Gram-positive cocci 73(42%),Gram-negative bacilli 81(46.5%),fungi 20(11.5%),The most common pathogens were coagulase-negative staphylococci,Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus.Vancomycin-and linezolid-,teicoplanin-resistant Staphylococcus aureus were not detected.G-bacteria Escherichia coli and Klebsiella pneumoniae have good sensitivity(67.8%-100%)to carbapenem,enzyme complexing agent and amikacin.Acinetobacter baumannii,Pseudomonas aeruginosa are poor sensitivity to antimicrobial drugs overall,Only meropenem,cefoperazone/sulbactam resistance is low.5.imaging features of lung:the nodular,lumpy,patchy and cord-like shadows,in some cases accompanied by cavity formation,pleural effusion.G+ bacteria lung CT showed multiple high density nodules in both lungs,the thin-walled hollow can be seen in it,surrounded by smooth,with patchy shadow;G-bacteria bloodstream infection involving the lungs showed multiple well-circumscribed nodule,large main patchy shadows,often associated with pleural effusion;Fungi bloodstream infections involving the lung CT show the two lung periphery or frequent subpleural nodules,the boundary is not clear,the edge is coarse visible "halo sign",Necrosis and cavitation can be seen in it,often accompanied by pulmonary interstitial damage,ground glass shadow change.6.treatment and prognosis:anti-infection treatment to all patients,treatment improved 127 cases(77.4%),treatment is ineffective 37 cases,accounting for 22.6%.19 cases of fungal bloodstream infections in 17 cases(89.5%)on a consolidated basis of disease,treatment improved in 11 cases,improvement rate was 57.9%,showing a trend of poor prognosis.In the Logistic multivariate analysis,age>60 years old,invasive mechanical ventilation,cancer were the independent risk factors of poor prognosis.Conclusions:1.Blood culture the G-bacteria higher than the G + bacteriaG in patients with bloodstream infection involving the lungs,while the hospital-acquired infections were with a high proportion of G-bacteria,and the community-acquired bloodstream infections were with a high proportion of G+bacteria.Lung imaging performance of different pathogens have different features.2.The prognosis related to the basic diseases and the infective pathogens.3.