小儿社区获得性耐甲氧西林金葡菌脓毒症11例临床分析

Clinical analysis of 11 children with sepsis caused by community-acquired methicillin-resistant staphylococcus aureus

目的探讨儿童社区获得性耐甲氧西林金黄色葡萄球菌脓毒症的临床特点。方法回顾性分析该院重症监护中心2012年1月—2013年12月收治的11例耐甲氧西林金葡菌脓毒症的发病情况及临床特点。结果 11例儿童发病前均系健康儿童;突发起病,分别以毒血症状(11例)、皮肤及软组织感染(10例)、脓毒性休克(5例)、坏死性肺炎(3例)为主要表现,疾病进展迅速。药敏显示,社区获得性耐甲氧西林金葡菌对万古霉素、利奈唑胺均敏感,对红霉素100%耐药,对克林霉素90.1%耐药。结论耐甲氧西林金葡菌脓毒症在儿童社区获得性感染中占有一定比例,具有一定的特征,皮肤软组织感染多见,出现坏死性肺炎预后欠佳。早期发现及时治疗是治愈的关键。

Objective To explore the clinical characteristics of children with sepsis caused by community-acquired methicillin-resistant staphylococcus aureus（CA-MRSA）. Methods The clinical data of 11 cases with CA-MRSA were analyzed retrospectively from Anhui Provincial Children＇s Hospital during Jan 2012 to Dec 2013. Results There were eleven cases of toxemic symptoms,10 cases of skin and soft tissue infection,5 cases of septic shock,and 3 cases of necrotizing pneumonia. Disease progression was rapid,and the culture positive rate with blood or exudation was high. The susceptibility tests showed CA-MRSA was susceptible to vancomycin,linezolid,resistant to erythromycin and clindamycin. Three cases died of the infection of CA-MRSA. Conclusions The sepsis caused by community-acquired methicillin-resistant staphylococcus aureus in children should be recognized,which were mostly infection in skin and soft tissue and had poor prognosis in necrotizing pneumonia. So early detection and early intervention is the key to the treatment.