临床儿科杂志
臨床兒科雜誌
림상인과잡지
2015年
1期
28-31
,共4页
耐甲氧西林金黄色葡萄球菌%脓毒症%儿童
耐甲氧西林金黃色葡萄毬菌%膿毒癥%兒童
내갑양서림금황색포도구균%농독증%인동
methicillin-resistant Staphylococcus aureus%severe sepsis%child
目的：分析儿童耐甲氧西林金黄色葡萄球菌(MRSA)感染导致严重脓毒症的临床特点及细菌耐药性。方法回顾性分析2010年1月至2013年12月收治的12例MRSA感染致严重脓毒症患儿的病史和细菌药敏试验资料。结果12例患儿中，男5例、女7例，年龄8 d~11岁，中位年龄1岁，9例为<1岁婴儿，均急性起病。5例表现为急性骨髓炎和/或化脓性关节炎，5例表现为坏死性肺炎伴脓胸，1例表现为坏死性筋膜炎，1例表现为血流感染；其中8例同时伴有皮肤及软组织感染，7例并发脓毒性休克，1例并发弥漫性血管内凝血。患儿C反应蛋白均显著升高，4例白细胞计数下降。药敏试验显示12株MRSA对万古霉素、利奈唑胺均敏感，对红霉素、克林霉素、复方磺胺甲噁唑有不同程度的耐药。经手术清创、胸腔闭式引流等治疗后，8例存活，4例死亡。结论 MRSA感染导致的严重脓毒症多见于婴儿，发病急、进展迅速，需要积极治疗。
目的：分析兒童耐甲氧西林金黃色葡萄毬菌(MRSA)感染導緻嚴重膿毒癥的臨床特點及細菌耐藥性。方法迴顧性分析2010年1月至2013年12月收治的12例MRSA感染緻嚴重膿毒癥患兒的病史和細菌藥敏試驗資料。結果12例患兒中，男5例、女7例，年齡8 d~11歲，中位年齡1歲，9例為<1歲嬰兒，均急性起病。5例錶現為急性骨髓炎和/或化膿性關節炎，5例錶現為壞死性肺炎伴膿胸，1例錶現為壞死性觔膜炎，1例錶現為血流感染；其中8例同時伴有皮膚及軟組織感染，7例併髮膿毒性休剋，1例併髮瀰漫性血管內凝血。患兒C反應蛋白均顯著升高，4例白細胞計數下降。藥敏試驗顯示12株MRSA對萬古黴素、利奈唑胺均敏感，對紅黴素、剋林黴素、複方磺胺甲噁唑有不同程度的耐藥。經手術清創、胸腔閉式引流等治療後，8例存活，4例死亡。結論 MRSA感染導緻的嚴重膿毒癥多見于嬰兒，髮病急、進展迅速，需要積極治療。
목적：분석인동내갑양서림금황색포도구균(MRSA)감염도치엄중농독증적림상특점급세균내약성。방법회고성분석2010년1월지2013년12월수치적12례MRSA감염치엄중농독증환인적병사화세균약민시험자료。결과12례환인중，남5례、녀7례，년령8 d~11세，중위년령1세，9례위<1세영인，균급성기병。5례표현위급성골수염화/혹화농성관절염，5례표현위배사성폐염반농흉，1례표현위배사성근막염，1례표현위혈류감염；기중8례동시반유피부급연조직감염，7례병발농독성휴극，1례병발미만성혈관내응혈。환인C반응단백균현저승고，4례백세포계수하강。약민시험현시12주MRSA대만고매소、리내서알균민감，대홍매소、극림매소、복방광알갑오서유불동정도적내약。경수술청창、흉강폐식인류등치료후，8례존활，4례사망。결론 MRSA감염도치적엄중농독증다견우영인，발병급、진전신속，수요적겁치료。
Objective To analyze the clinical features and bacterial drug resistance of severe sepsis caused by methicil-lin-resistant Staphylococcus aureus (MRSA) infections in children. Methods The clinical data and results of antibiotic suscep-tibility test in 12 children with severe sepsis caused by MRSA infections from January 2010 to December 2013 were analyzed retrospectively. Results Among 12 children, there were 5 boys and 7 girls. Their age ranged from 8 days to 11 years, with a me-dian age of 1 year and there were 9 infants. All cases presented with acute onset which included 5 cases of acute osteomyelitis or purulent arthritis, 5 cases of necrotizing pneumonia with pyothorax, one case of necrotizing fasciitis and one case of bloodstream infection. 8 cases were complicated by skin and soft tissue infection, 7 cases by septic shock and 1 case by disseminated intravas-cular coagulation. The levels of C-reactive protein were increased in all children and white blood cell counts were decreased in 4 children. The susceptibility testing showed MRSA was sensitive to vancomycin and linezolid, and resistant to erythromycin, clin-damycin and compound sulfamethoxazole. After treatment with surgical debridement and closed-chest drainage, 8 cases survived and 4 cases died. Conclusions The severe sepsis caused by MRSA infections was common in infants with sudden onset and rapid progress, so active treatments are needed.
