新生儿葡萄球菌烫伤样皮肤综合征十年临床分析

Clinical analysis of staphylococcal scalded skin syndrome in neonate during ten years

目的探讨葡萄球菌烫伤样皮肤综合征(staphylococcal scalded skin syndrome,SSSS)在新生儿中的发病诱因、临床表现、实验室检查特点以及诊治情况,为新生儿SSSS的诊治提供参考。方法应用流行病学方法对重庆市儿童医院2000年1月至2010年1月十年间收治的20例新生儿SSSS病例进行一项回顾性研究。结果本组共20例;前5年的1例,后5年19例,平均年龄约为18天2小时;本组病例中18例(90%)无明确的发病诱因。65%于夏秋季节患病,农村地区以及男孩多见;100%有红斑伴水疱和随后出现脱屑;10例检查心肌酶谱均异常;18例中44.4%分离出金黄色葡萄球菌;近3年葡萄球菌药敏试验分析显示阿莫西林/棒酸、头孢菌素类以及苯唑西林耐药率均达27.3%;85%双联抗生素治疗有效,心肌酶谱异常者均予以保心药物,全部治愈,无并发症发生。结论近年来SSSS患病新生儿呈增多趋势,新生儿期出现颜面部急性红斑和口周黏膜损害应更加警惕,目前高敏感率且治疗有效的药物宜选用头孢菌素类和半合成青霉素复合制剂,在病程早期可加用保心药物。

Objective To investigate the predisposing factors,clinical manifestations,laboratory features,diagnosis and treatment of neonate staphylococcal scalded skin syndrome（SSSS） so as to provide reference for its diagnosis and treatment.Method An observational cohort study were presented.20 cases of neonate SSSS monitored were reviewed at Chongqing Children’s Hospital in the past decade（from January 2000 to January 2010）.Result 20 patients were obtained,1 in the first 5 years and 19 in the following years.The mean age at diagnosis was 18 days and 2 hours.18 patients（90%） had no definite inducement.65% of the cases were occured in summer and autumn,more common in countryside and boys.Main clinical signs were erythroderma with blisters and subsequent desquamation（100%）.Laboratory routine inspection found that myocardial enzymes were abnormal in all 10 checked patients.The isolation rate of Staphylococcus aureus was up to 44.4% among 18 cases;Susceptibility testing analysis for 11 strains of Staphylococcus in recent three years showed that the resistance rate to amoxicillin/clavulanic acid,cephalosporins and oxacillin were 27.3%.85% responded positively to double-antibiotic therapy.Heart-protecting drugs were administered to patients with abnormal myocardial enzymes.All patients were cured without complications.Conclusion The prevalence of neonate SSSS show an increasing trend in recent years.The emergence of acute facial erythema and perioral mucosal lesions should be monitored more vigilantly.Currently,cephalosporins and semi-synthetic penicillin compound preparation are the choice for effective treatment.Heart-protecting drugs can be added in early course of the disease.