儿童突发耐甲氧西林金黄色葡萄球菌肠炎1例及文献复习

A case report of a child with sudden enteritis caused by methicillin-resistant Staphylococcus aureus and literature review

耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)极少引起肠炎,MRSA肠炎一般多见于长期使用抗生素及胃肠手术后的患者。本例患儿无长期用药史及手术史,突然出现发热、呕吐、转移性右下腹痛而就诊,病初疑诊阑尾炎,完善腹部计算机断层扫描(computed tomography,CT)检查后未发现阑尾炎影像学征象,反而可见肠管异常扩张及气粪潴留,经肛管引流出大量墨绿色水样便。经咽拭子和粪便病原学检查,患儿确诊MRSA肠炎。给予万古霉素口服抗感染及对症治疗后,患儿康复出院。本文通过分析本病例及MRSA肠炎相关文献,对MRSA肠炎的发病诱因、临床表现、治疗方案进行深入剖析,为MRSA肠炎的规范化诊疗提供新的思路。

Methicillin-resistant Staphylococcus aureus(MRSA)rarely causes enteritis,and MRSA enteritis is generally more common in patients with long-term antibiotic use and gastrointestinal surgery.In this case,the child had no history of long-term medication and surgery,and suddenly developed fever,vomiting,shifting right lower abdominal pain.Appendicitis was suspected at the beginning,but no imaging signs of appendicitis were found on the abdominal computed tomography(CT),with abnormally dilated intestinal tube and fecal retention,and a large amount of dark green watery stool was drained through the canal.After etiological tests of throat swab and fecal specimens,the child was diagnosed with MRSA enteritis.After oral administration of vancomycin and symptomatic treatment,the child recovered and was discharged from hospital.This case and MRSA enteritis-related literatures were reviewed to conduct an in-depth analysis of the pathogenesis,clinical manifestations,treatment plan of MRSA enteritis,so as to provide new ideas for the standardized diagnosis and treatment of MRSA enteritis.