金黄色葡萄球菌败血症临床分析及治疗探讨

Staphylococcus aureus Septicemia: Clinical Analysis and Treatment

目的 探讨金黄色葡萄球菌败血症的临床特点、耐药性及治疗转归情况。方法 对血培养证实为金黄色葡萄球菌败血症 36例患者进行分析。结果 36例患者中男∶女为 3∶ 1,各年龄组均可患病 ,以皮肤及呼吸道引起者常见为 5 2 .8% ;临床 10 0 %有发热 ,常伴寒颤 ,引起两个以上脏器损害 36 .1% ,外周血白细胞高 ,中性粒细胞>0 .80者 6 9.4 % ;血培养生长金黄色葡萄球菌 ,对青霉素 - G耐药率达 87.9% ,万古霉素 10 0 %敏感 ;治疗痊愈 18人 (5 0 % )、显效 8人 (2 2 .2 % )、进步 5人 (13.9% )、死亡 5人 (13.9% )。结论 临床上疑有金黄色葡萄球菌败血症的病例尽早做血、骨髓培养及药敏试验 ,联合应用敏感药物治疗 ;无药敏试验的医院可选用耐酶青霉素加第一代或第二代头孢菌素、耐酶青霉素加硫酸阿米卡星或氧氟沙星、如为耐甲氧西林金黄色葡萄球菌 (MRSA)感染可选用进口万古霉素。

OBJECTIVE To study clinical features, resistant agent and treatment of Staphylococcus aureus septicemia. METHODS To analyze 36 cases with S. aureus septicemia which were proved by blood culture. RESULTS The 36 cases (male/female, 27/9) were distributed in each stage of ages. Skin and respiratory tract infection were common, accounted for 52.8% (19/36). Clinical symptoms were fever with rigor. Thirteen cases (36.1%) were found damages in more than 2 organs and 25 cases (69.4%) showed leucocytosis with neutrophil >0.80. Blood culture of S. aureus was positive. The resistant rate to penicillin G was 87.9%, but vancomycin was sensitive; 18 cases (50%) recovered well, 8 cases (22.2%) were treated effectively, 5 cases (13.9%) improved, 5 cases (13.9%) dead. CONCLUSIONS Blood culture and antibiotic susceptibility test should be taken when the patient was suspected with S. aureus septicemia. If antibiotic susceptibility test can′t be taken there may be treated it by enzyme resistant penicillin plus the first generation or the second generation of cephalosporins, enzyme resistant penicillin plus amikacin or ofloxacin, MRSA can be treated by vancomycin.