Overview of Enterococcus pneumonia
Enterococcal pneumonia is an acute purulent inflammation of the lungs caused by enterococci, accounting for a minority of bacterial pneumonias, mostly nosocomial infections, which have been gradually noticed and emphasized in recent years.
Etiology
Enterococci belong to the genus Streptococcus, also known as Group D Streptococcus or Streptococcus faecalis, and are gram-positive bacteria. According to DNA homology analysis, it is now listed in another genus, namely Enterococcus, mainly including Enterococcus faecalis (EfaecaL, also known as fecal streptococci) and enterococci (E, faecium, also known as urogenital streptococci), and the former is more common to cause disease. Enterococci are generally not hemolytic, enterococci salt-resistant, heat-resistant, able to grow in the medium containing 6% NaCl, and can survive for 30 minutes at a temperature of 62 ℃. Enterococci for the normal flora of the human digestive tract, the oropharynx can also be cultured to fecal enterococci, pathogenicity is weak, in general, not pathogenic. However, invasion of human tissues can cause corresponding infections. Parasitic enterococci in the oropharynx if mistakenly inhaled into the respiratory tract, especially nasal nutrition and mechanical ventilation and other treatments, may cause enterococcal pneumonia in which Enterococcus faecalis has a significantly higher chance of causing disease than Enterococcus faecalis. Invasive procedures and extensive use of broad-spectrum antibiotics are strongly associated with enterococcal infections.
Symptoms
Enterococcal pneumonia is very rare among the types of bacterial pneumonia. Its clinical presentation is not very different from that of pneumonia due to pus-filled bacteria in general. Symptoms include fever, cough, coughing up purulent sputum, chest pain, and shortness of breath. Signs are solid signs of pneumonia. In a few patients, enterococcal sepsis can be combined with shock and diffuse intravascular coagulation (DIC), which is critical and can lead to death, mainly in patients with nosocomial infections.
Examination
1. Laboratory examination
Peripheral blood tests show elevated white blood cell count. When combined with bacteremia or sepsis, blood bacterial culture may be positive.
2. Other auxiliary examinations
X-ray chest radiograph shows patchy hyperdensity or lobar hyperdensity.
Diagnosis
Clinically, it mainly relies on sputum or anti-pollution brush through fiberoptic bronchoscopy in the lower respiratory tract or bronchoalveolar lavage (BAL), the lavage fluid for quantitative bacterial culture and identification to confirm the diagnosis. If the patient has septic pneumonia manifestations, and there is a history of invasive operation such as nasal feeding nutritional therapy, and clinically ineffective treatment with penicillin or cephalosporin antibiotics, the possibility of enterococcal pneumonia should be considered, and further aetiological examination should be carried out. Enterococcal pneumonia should be differentiated from other pneumonias caused by purulent bacteria, mainly relying on pathogenetic examination.
Complications
In a few patients, enterococcal sepsis may be combined with enterococcal sepsis.
Treatment
The drug resistance rate of enterococci is very high, and they are often resistant to penicillin and cephalosporin antibiotics. Vancomycin, ampicillin, piperacillin, erythromycin or combination with quinolone antibacterial drugs can be used.
Prognosis
The prognosis for simple enterococcal pneumonia treated with sensitive antibiotics is generally good. If antibiotics are not used properly, enterococci can cause sepsis and can lead to death. Linezolid can be used to treat infections caused by enterococci.
Prevention
Aggressively treat the underlying disease and avoid misuse of antimicrobials by strict aseptic practices.