社区获得性耐甲氧西林金黄色葡萄球菌致复杂性菌血症1例并文献复习

Complicated bacterima caused by community associated methicillin-resistant staphylococcus aureus:a case report and literature review

目的总结社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)所致复杂性菌血症的临床特点及治疗决策。方法回顾性分析1例社区获得性耐甲氧西林金黄色葡萄球菌致复杂性菌血症患者的临床资料,并查阅相关文献进行分析。结果既往体健的青少年患者在外伤1周后出现全身感染中毒症状。经过全身各系统检查,血培养示:耐甲氧西林金黄色葡萄球菌。肺部CT示:双肺多发结节、实变,伴有空洞形成及胸腔积液。右下肢MRI示化脓性骨髓炎及软组织肿胀。使用万古霉素(1.0g,q6h)治疗后,患者仍持续高热。后加用利奈唑胺注射液(0.6g,q12h)联合万古霉素抗感染及更改万古霉素给药途径后,患者体温逐渐恢复正常,治疗有效。经长达2个月的治疗,患者痊愈出院。结论社区获得性耐甲氧西林金黄色葡萄球菌引起的菌血症在我国发病率极低,临床医生应提高对该类少见病的认识。万古霉素联合利奈唑胺是一种有效的用药方法,需更多的临床经验论证。

Objective To summarize the clinical characteristics and treatment of complicated bacterima caused by community associated methicillin-resistant staphylococcus aureus(CA-MRSA). Methods Clinical data of one case of complicated bacterima caused by CA-MRSA was retrospectively analyzed, and the related literatures were reviewed for analysis. Results Severe infective symptoms occurred in a healthy young boy on the seventh day after injury. After examination, the cultures of soft tissue abscesses from right lower extremity and blood during hospitalization were positive for MRSA. The computed tomography(CT)of the chest showed high density mass shadow with cavities in bilateral lung lobes and pleural effusion. And the magnetic resonance imaging(MRI)of right lower extremity indicated pyogenic osteomyelitis and soft tissue tympanites. After usage of Vancomycin(1.0 g,q6 h), the patient still had a high fever. By changing administration of vancomycin and combination of vancomycin and linezolid, the temperature of the patient reached to normal. It proved to be useful. After two months treatment, the patient recovered and discharged. Conclusion Potentially lethal infection caused by CA-MRSA is not very common in China.It is necessary for our clinicians to realize this disease. This successful case provides an encouraging signal that the combination of vancomycin and linezolid may be useful for the treatment of MRSA bacteremia and it still needs more experiences to prove.