CAJ | 학술논문

目的：总结儿童金黄色葡萄球菌播散感染(DSAI)的临床特点及治疗。方法回顾分析2006年1月至2013年12月住院治疗的14例DSAI患儿的临床表现、治疗及转归资料。结果14例DSAI患儿均为社区获得性感染，起病中位年龄15个月(6 d~13岁)，男女各半；患儿均有发热，除发热外的首发症状为皮肤软组织感染6例，肢体、关节肿痛5例；白细胞计数、C反应蛋白明显升高。化脓性感染部位为皮肤软组织者12例(85.7%)、肺部12例(85.7%)、骨骼4例、关节3例、中枢神经系统3例、心包1例；其中皮肤软组织合并肺部感染10例(71.4%)。9例行皮肤软组织脓肿切排术，3例行关节清创后封闭负压引流(VSD)术，3例行骨髓炎病灶清除后VSD术，3例行胸腔闭式引流术。所有患儿均使用万古霉素和/或利奈唑胺抗感染，5例辅以利福平，11例联合丙种球蛋白调节免疫治疗。12例(85.7%)临床治愈及好转。结论皮肤软组织、骨骼及关节感染是DSAI的主要诱发因素；在应用有效抗生素基础上，辅以丙种球蛋白可能有更佳效果。
목적：총결인동금황색포도구균파산감염(DSAI)적림상특점급치료。방법회고분석2006년1월지2013년12월주원치료적14례DSAI환인적림상표현、치료급전귀자료。결과14례DSAI환인균위사구획득성감염，기병중위년령15개월(6 d~13세)，남녀각반；환인균유발열，제발열외적수발증상위피부연조직감염6례，지체、관절종통5례；백세포계수、C반응단백명현승고。화농성감염부위위피부연조직자12례(85.7%)、폐부12례(85.7%)、골격4례、관절3례、중추신경계통3례、심포1례；기중피부연조직합병폐부감염10례(71.4%)。9례행피부연조직농종절배술，3례행관절청창후봉폐부압인류(VSD)술，3례행골수염병조청제후VSD술，3례행흉강폐식인류술。소유환인균사용만고매소화/혹리내서알항감염，5례보이리복평，11례연합병충구단백조절면역치료。12례(85.7%)림상치유급호전。결론피부연조직、골격급관절감염시DSAI적주요유발인소；재응용유효항생소기출상，보이병충구단백가능유경가효과。
Objective To study the disseminated Staphylococcus aureus infection (DSAI) in children. Method Clinical features, treatment and prognosis data of 14 children with DSAI admitted to Yuying Children’s Hospital Afifliated to Wenzhou Medical University from January 2006 to December 2013 was retrospectively reviewed. Results 14 children with DSAI occurred in community, median age:15m (range 6d–13y);50%male (7 cases). All patients presented with fever. Addition to fever, the ifrst symptom was skin and soft tissue infections (SSTIs,6 cases) as well as limb and/or joint pain (5 cases). Among children with DSAI, white blood cell count and C-reactive protein values increased signiifcantly. Pyogenic infection site were skin and soft tissue in 12 cases (85.7%), pulmonary (12 cases), bone (4 cases), joint (3 cases), central nervous system (3 case), and pericardium (1 case). SSTIs concurrent with pulmonary infection was found in 10 cases (71.4%). Incision and drainage of skin and soft tissue abscesses were performed in 9 cases, joint debridement and vacuum sealing drainage (VSD) in 3 cases, osteomyelitis debridement and VSD in 3 cases, and closed chest drainage in 3 cases. All cases received vancomycin and/or linezolid treatment, 5 cases supplemented by rifampicin, and intravenous immune globulin therapy was administered in 11 cases. Clinical manifestations were cured or improved in 12 cases (85.7%). Conclusions Clinical diagnosis of DSAI in children needs to be vigilant. SSTIs, bone and joint infections were major precipitating factors. Intravenous immune globulin therapy was supplemented to the application of antibiotics, which might get better clinical outcomes in children.