非ST段抬高型心肌梗死患者肺炎克雷伯菌所致感染性心内膜炎1例

M.Yu. Zhilinskiy, N. Mukhina, I. Komarova, S. Rachina, N. A. Cherkasova, A.B. Borisov, L. Fedina, S. M. Nasrulloeva
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引用次数: 0

摘要

本文报道一例罕见的56岁男性患者,因肺炎克雷伯菌引起的先天性主动脉瓣感染性心内膜炎(IE),并无已知的诱发IE的危险因素。由于缺乏可被视为菌血症来源的近期干预措施,缺乏临床表现和无典型并发症,该患者的IE诊断具有挑战性。经食管超声心动图检测主动脉瓣植被。分离肺炎克雷伯菌对所有抗生素均敏感。抗菌治疗(头孢吡肟6 g/天静脉注射,住院2周,头孢曲松4 g/天静脉注射,头孢克肟400 mg/天口服,门诊共4周)导致IE体征和症状完全消失,实验室异常,植被缩小。该患者不需要手术治疗。
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Infective endocarditis caused by Klebsiella pneumoniae in a patient with non ST elevation myocardial infarction
A rare clinical case of native aortic valve infective endocarditis (IE) caused by Klebsiella pneumoniae in a 56-year old man without known risk factors predisposing to the development of IE is presented. Diagnosis of IE in this patient was a challenge due to the lack of recent interventions that could be considered as a source of bacteremia, scarce clinical manifestation and absence of typical complications. Aortic valve vegetation was detected by transesophageal echocardiography. K. pneumoniae isolate was susceptible to all antibiotics tested. Antibacterial therapy (cefepime 6 g/day IV for 2 weeks in the hospital followed by ceftriaxone 4 g/day IM and cefixime 400 mg/day PO, a total of 4 weeks as an outpatient) resulted in a complete resolution of IE signs and symptoms, laboratory abnormalities as well as vegetation size decrease. Surgical treatment was not required in this patient.
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