儿童耐甲氧西林金黄色葡萄球菌血流感染的临床特征

The clinical characteristics of bloodstream infection of methicillin-resistant Staphylococcus aureus in children

目的分析儿童耐甲氧西林金黄色葡萄球菌(MRSA)血流感染的临床特征。方法选取2012年1月至2016年12月三门峡市中心医院收治的21例MRSA血流感染患儿,回顾性分析患儿的性别、年龄、原发疾病、临床表现、实验室检查、影像学检查、治疗和转归等。结果 21例患儿中男15例,女6例,年龄≤3岁者19例。15例社区感染患儿中,原发病为皮肤软组织感染9例,烧伤后感染5例,肌内注射1例。6例院内感染患儿在发生MRSA血流感染前均有侵袭性操作。所有患儿均有高热、精神、食欲差等全身感染中毒症状。合并多脏器功能衰竭6例,弥散性血管内凝血4例,脓毒性休克2例,颅内感染1例,化脓性关节炎1例。合并深部软组织脓肿3例,中毒性肠麻痹3例,金黄色葡萄球菌皮肤烫伤样综合征2例。患儿CRP和降钙素原均升高。所有患儿影像学表现为斑片状阴影合并脓胸,其中12例社区感染患儿的肺部影像学检查还显示广泛肺脓肿形成及坏死性肺炎。药敏试验显示菌株对万古霉素、替考拉宁、利奈唑胺均敏感,对红霉素、克林霉素及复方新诺明有不同程度的耐药。经过治疗,16例治愈或好转。结论儿童MRSA血流感染的好发年龄为3岁以下,病情重,进展快,耐药性强,易感因素为皮肤软组织损伤和侵入性操作。

Objective To analyze the clinical characteristics of bloodstream infection of methicillin-resistant Staphylococcus aureus(MRSA)in children.Methods Twenty-one children with the bloodstream infection of MRSA admitted to Sanmenxia Central Hospital from January 2012 to December 2016 were selected and their gender,age,primary diseases,clinical manifestations,laboratory examination,imaging examination,treatment and outcome were retrospectively analyzed.Results Among 21 children,15 cases were males,and 6 cases were females.A total of 19 cases were younger than or equal to 3 years old.Among 15 cases of community infection,9 cases were caused by skin soft-tissue infection and 5 cases were caused by postburn infection,and 1 case was caused by intramuscular injection.Six cases infected in hospital were all caused by invasive procedure before bloodstream infection of MRSA.All of the children had symptoms of systemic infection and poisoning,such as high fever,poor spirit and appetite.There were 6 cases complicated with multiple organ failure,4 cases with disseminated intravascular coagulation,2 cases with septic shock,1 case with intracranial infection and 1 case with suppurative arthritis.There were 3 cases complicated with deep soft tissue abscess,3 cases with toxic enteroparalysis and 2 cases with Staphylococcus aureus scalded skin syndrome.The levels of CRP and procalcitonin were both increased in children.The imaging findings of all children were patchy shadows combined with empyema.Pulmonary imaging examination of 12 children with community infection also showed extensive lung abscess formation and necrotic pneumonia.The drug sensitivity test showed that MRSA was sensitive to vancomycin,teicoplanin and linezolid,and had different degrees of drug resistance to erythromycin,clindamycin and compound sulfamethoxazole.A total of 16 cases were cured or improved after treatment.Conclusion The children with the bloodstream infection of MRSA are most likely to be under 3 years old,with severe illness,rapid progress and strong drug resistance.The susceptible factors are skin and soft tissue injury and invasive operation.