耐甲氧西林金黄色葡萄球菌感染致坏死性肺炎临床特点12例分析

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目的分析儿童耐甲氧西林金黄色葡萄球菌(MRSA)感染导致坏死性肺炎的临床特征,对临床诊治提供参考依据。方法回顾性分析2009年1月-2015年5月收治的12例MRSA感染致坏死性性肺炎患儿的病史资料。结果12例患儿中,男5例、女7例,年龄9月~3岁,中位年龄23月,均为急性起病,既往体健,热程12~36d,住院天数28~70d。均表现为高热、咳嗽及感染中毒症状。5例发病时即为脓毒血症,7例以发热、咳嗽入院,8例有呼吸困难,6例伴有皮疹。10例可闻及细湿啰音,所有病例均有不同程度的胸腔积液,2例合并金黄色葡萄球菌皮肤烫伤样综合征,2例在病程中合并深部软组织脓肿,无合并急性骨髓炎或化脓性关节炎病例。外周血白细胞总数(14.8×109/L~42.36×109/L)、中性粒细胞(78.8%~91.9%)。C反应蛋白(68~140mg/L),血沉(52~114mm/h)及降钙素原(0.8~3.7ng/ml)。胸腔积液检查外观均为粘稠黄色,细胞数明显升高(5 800~12 560)×106/L,蛋白35~60g/L药敏试验显示所有病例均对万古霉素敏感,对青霉素、苯唑西林、红霉素及头孢类抗生素耐药。病初胸部影像学表现为肺纹理增粗或肺大片状高密度灶,迅速进展成为多发囊泡影或空腔。所有病例应用万古霉素或利奈唑胺控制感染及对症治疗,胸腔积液多者给予胸腔闭式引流或胸腔清脓术。所有病例随访半年,于6个月左右复查肺部CT基本完全恢复,无进行肺叶切除病例,预后较好。结论MRSA感染致坏死性肺炎多见3岁以内儿童,发病急、进展迅速,临床上以高热、咳嗽、肺组织坏死为特点,及时积极治疗预后较好。 Objective To analyze the clinical characteristics of children with methicillin-resistant Staphylococcus aureus (MRSA) infection and to provide a reference for clinical diagnosis and treatment. Methods The clinical data of 12 children with necrotizing pneumonia who were infected by MRSA from January 2009 to May 2015 were retrospectively analyzed. Results Among the 12 children, there were 5 males and 7 females, aged from 9 months to 3 years old, with a median age of 23 months. All of them were acute onset, with a history of 12 ~ 36 days and a length of stay of 28 ~ 70 days. All showed fever, cough and infection symptoms. Five were sepsis at onset, 7 were fever and were hospitalized with cough, with dyspnea in 8 and rash in 6. 10 cases can be heard and fine wet rales, all cases have different degrees of pleural effusion, 2 cases of Staphylococcus aureus scalded skin syndrome, 2 cases of deep soft tissue abscess in the course of disease without acute osteomyelitis or Cases of suppurative arthritis. The total number of peripheral blood leukocytes (14.8 × 109 / L ~ 42.36 × 109 / L), neutrophils (78.8% ~ 91.9%). C-reactive protein (68 ~ 140mg / L), ESR (52 ~ 114mm / h) and procalcitonin (0.8 ~ 3.7ng / ml). Pleural effusion examination showed that the appearance of viscous yellow, significantly increased cell number (5 800 ~ 12 560) × 106 / L, protein 35 ~ 60g / L drug sensitivity test showed that all cases were susceptible to vancomycin, penicillin, Oxacillin, erythromycin and cephalosporins antibiotic resistance. Early chest imaging findings of lung thickening of the lungs or large lung-shaped high-density lesions, the rapid progress of multiple vesicles or cavities. All cases of vancomycin or linezolid control of infection and symptomatic treatment, pleural effusion and more to give thoracic drainage or pleural clear pus. All patients were followed up for six months, at 6 months or so to review the basic complete recovery of lung CT, without lobectomy cases, the prognosis is good. Conclusion MRSA infection causes necrotizing pneumonia more common in children under 3 years of age, the incidence of acute and rapid progress in clinical high fever, cough, lung tissue necrosis is characterized by timely and aggressive treatment of the prognosis is good.
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