金黄色葡萄球菌感染致新生儿急性骨髓炎的临床分析

Clinical analysis of 14 cases of neonatal acute osteomyelitis induced by Staphylococcus aureus infections

目的探讨金黄色葡萄球菌致新生儿急性骨髓炎的临床特点,总结诊断与治疗经验。方法回顾性分析安徽省儿童医院重症医学科14例新生儿金黄色葡萄球菌致急性骨髓炎临床、影像学表现、治疗及预后。结果该14例患儿中MSSA 8例,MRSA 6例;其中男9例、女5例,年龄6~28d,住院28~45d;烦躁或精神差、拒乳14例,发热7例,患肢拒动12例,局部红肿11例,85%以上患儿有多种表现;WBC（3.1~42.38）×10^9/L,CRP、PCT、ESR均明显升高;9例MRI提示骨膜下或骨髓腔脓肿,切开引流术后行冲洗吸引,5例未形成脓肿;该14例中9例治愈,2例累及髋关节,股骨头坏死,2例累及干骺端,患肢缩短或成角畸形;1例出现脓毒性休克死亡。结论金黄色葡萄球菌致新生儿急性骨髓炎少见,但临床怀疑金黄色葡萄球菌感染者尽早经验性静脉使用抗菌药物,包括万古霉素及必要的外科治疗,若错过最佳治疗时间,可能遗留严重后遗症。

OBJECTIVE To evaluate the neonatal Staphylococcus aureus clinical characteristics of acute osteomyelitis,and to summarize the experience of diagnosis and treatment.METHODS A retrospective analysis of clinical Anhui Children＇s Hospital Neonatal Critical Care Medicine 14 cases of acute osteomyelitis caused by S.aureusimaging findings,treatment and prognosis were carried out.RESULTS In the 14 cases of children,there were 8cases of MSSA and 6cases of MRSA,including 9males and 5females,aged 6days-28 days,length of stay 28days-45 days,14cases with irritability or poor spirit,refusing milk,7cases with fever,12 cases with limb refused to move,11 cases with local swelling,and there were more than 85% of children who had multiple performances.The white blood cell count was（3.1~42.38）×10^9/L,and the CRP,PCT,ESR increased significantly.9cases MRI examinations showed formation of subperiosteal abscesses or bone marrow cavity,be washed after incision and drainage lines attract.5cases did not form an abscess.A total of 14 cases of children with 9cases who were cured,2cases involving the hip joint,necrosis of the femoral head,2cases involving the metaphyseal,limb shortening or angular deformity occurs,and the other 1case who occured septic shock,leading to death.CONCLUSIONDespite acute osteomyelitis caused by S.aureus neonatal is rare,but clinical suspicion of S.aureusinfection empiric intravenous antibiotics as soon as possible,including vancomycin and the necessary surgery.If missed the best treatment time,might be left serious sequelae.