成人社區型急性細菌感染

Community-Acquired Acute Bacterial Infections in Adults

雖然現今醫學技術對細菌性感染的臨床診斷及治療相當地進步，但是部分的急性感染症，常因其病情進展之快速導致死亡。此類病患，即使及時給予適當的抗生素、升壓劑和呼吸器維生，但常在幾天內因病情進展極速惡化，往往令其家屬無法接受。除了患者及早就醫外，醫護入員對於這些急性疾病也必須有高度的警覺性，因其維繫著患者的生死。所以醫護人員應事先清楚告知、分析病情與溝通，避免造成醫療糾紛。本文章列舉在台灣較可能遭遇到數種成人社區型細菌感染性急症（Vibrio vulnificus、Aeromonas species、Staphylococcu saureus、group A streptococci、Neisseriam eningitidis、Klebsiella pneumoniae），皆可能引i曼敗血性休克，且各有其高危險群。其中有些感染可藉由及早治療避免死亡，如何掌握先機，是刻不容緩的課題。

Recently, the current medical technology, clinical diagnostic techniques, and treatment for bacterial infections have considerably advanced. However, some community-acquired acute bacterial infections advance more rapidly than expected by the doctors or the patient’s family. The conditions of all the patients may worsen within a few days of infection in spite of administration of adequate antibiotics and inotropic agents and timely ventilator support; the condition of the patients rapidly worsen, often leaving their families unable to cope with the situation. Besides educating the patients to seek medical advice at an early stage, medical personnel should also be alert and able to handle emergency, which is a factor crucial in improving patients’ survival. Therefore, the medical personnel should thoroughly explain and analyze the condition in detail and communicate in advance to avoid any medical dispute. This article enumerates several types of acute bacterial diseases that occur in adults and are probably prevalent in Taiwan, such as infections with Vibrio vulnificus, Aeromonas species, Staphylococcus aureus, group A streptococci, Neisseria meningitidis, and Klebsiella pneumoniae. All these bacteria initiate septic shock; further, patients infected with each of these species constitute a high-risk group. Among the infections with the abovementioned species, some infections can perhaps be treated at an early stage in order to avoid death of the patient. How to grasp the first chance is a very urgent subject.