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Abstract: Bacterial pneumonia is a common form of pneumonia. The patient presented with respiratory symptoms such as cough, sputum and mucous yellow sputum 10 days ago, and was admitted to the hospital with CT suggestive of inflammation of the left lung and further examined for bacterial pneumonia. The patient was given anti-inflammatory treatment with piperacillin sodium tazobactam sodium for injection as well as bronchoscopy-assisted sputum evacuation. After treatment, the patient was discharged from the hospital with good general condition and gradual recovery of all indexes.
Basic information】Male, 42 years old
Type of disease】Bacterial pneumonia
Hospital】The First Hospital of Harbin Medical University
Date of consultation】May 2022
Treatment plan] Bronchoscopy + bronchoscopic aspiration + medication (piperacillin sodium tazobactam sodium for injection + aminoglutethimide hydrochloride injection + menthol insulin injection + glycine insulin injection)
[Treatment cycle] 10 days of inpatient treatment, 1 month of outpatient review
Treatment effect】The condition has been controlled and all indicators are improving
I. Initial consultation
The patient reported coughing and sputum after catching cold 10 days ago, with high sputum volume, yellow mucous sputum, effortful coughing, chest tightness, no obvious shortness of breath, no awakening at night, able to lie down, accompanied by severe coughing and chest pain during deep breathing, mainly on the left side, pinprick-like pain, no discharge pain, no fever, hemoptysis, malaise, night sweats and other symptoms. The cough and sputum decreased and the chest pain was not relieved after 10 days of out-of-hospital intravenous clindamycin hydrochloride injection. He also had a previous history of diabetes mellitus for 1 year, denied a history of hypertension, ate irregularly on weekdays, and had daily subcutaneous insulin injections to control blood glucose, which fluctuated greatly. Combined with the patient’s cyanosis of the mouth and lips on admission, the CT of the lung suggested inflammation of the left lung, and he was subsequently admitted with pneumonia.
II. Treatment history
After the patient was hospitalized, sputum culture, cardiac ultrasound, blood gas analysis, and seven times of blood glucose monitoring were checked, and the test results suggested that the patient had streptococcal infection, and the clinical diagnosis was bacterial pneumonia. After communicating with the patient and family members about the patient’s condition and choosing a treatment plan based on the above examination results, the patient was advised to receive oxygen to improve chest tightness, and after fully communicating with the patient and family members about the risks and necessity of bronchoscopy, he was treated with bronchoscopic aspiration and sent to alveolar lavage fluid for NGS testing, and was given piperacillin sodium tazobactam injection for anti-infection and ambroxol hydrochloride injection for sputum treatment. The patient was also encouraged to discharge sputum, monitor blood glucose, eat regularly, and apply (menthol insulin injection + glargine insulin injection) to control blood glucose on time and according to the dosage.
III. Treatment effect
After adopting these measures, the patient’s lung CT showed that the patient’s lung images were significantly absorbed, the cough was significantly reduced, the sputum volume was significantly reduced, the patient’s chest pain was relieved, the inflammatory indexes were basically normalized on review, the patient’s pre- and post-meal glucose was controlled in the normal range, and the patient’s lack of oxygen was corrected on review of blood gas analysis, and the patient was discharged successfully after 10 days of hospitalization when his clinical symptoms disappeared. The patient was asked to come back to the hospital for a review in one month.
IV. Notes
We are glad that the patient’s condition improved after treatment. Before discharge, we instructed the patient to pay attention to rest, ventilate regularly, reduce going out and do a good job of protection, keep the air in the house clean and fresh, eat more light, easily absorbed food rich in vitamins and proteins to increase the nutrition of the body, monitor the change of body temperature, if the symptoms are relieved after 1 month, it is necessary to go to the hospital for follow-up to avoid the recurrence of the disease, and at the same time, if If symptoms appear, it is necessary to seek medical examination and cooperate with treatment. You can do some mild exercises during the day to increase the body resistance and promote recovery.
V. Personal insight
The patient in this case had a typical bacterial pneumonia and was discharged from the hospital after symptomatic treatment with medication. However, sometimes bacterial pneumonia is not a single causative agent, in which atypical pathogens mixed with caustic bacteria are more common. For patients with severe, difficult and poor treatment results, we should try to improve the pathogenic examination and select appropriate antibacterial drugs according to the type of bacteria. While the typical symptoms of bacterial pneumonia include fever, cough, sputum and chest pain, patients with these symptoms need active anti-infection and phlegm treatment, and symptomatic supportive therapy is equally important, such as more rest, better nutrition and diligent ventilation.