Objective To analyse the clinical effect of methicillin-resistant staphylococcus aureus(MRSA) necrotizing pneumonia in children. Method A retrospective analysis was performed based on the clinical records,laboratory data and treatment effects which were collected from 12 cases with CA-MRSA necrotizing pneumonia. Results Of the 12 cases,5 cases were male and 7 female.The median age was 23 months (8 months ~3 years old) and they were healthy before admission.They were febril for 12~ 36 days and hospital day was 28 ~70 days.The general condition of all cases were poor,all had high fever and cough.Dyspnea was found in eight children.Fine rales were found on 10 cases.Sighs of pleural effusion were discovered by physical examination and chest X-ray.During the course of admission,2 children complicated with deep soft tissue abscess,2 cases complicated with staphylococcus scalded skin syndrome and the other complicated with sepsis syndrome.WBC count was (14.8~42.36)×109/L and neutruophil was 78.8%~91.9% in peripheral blood routine test.Erythrocyte sedimentation rate was 52~114 mm/h and C-reactive protein was 68~140 mg/L.The pleural effusion biochemistry and routine test revealed a WBC count of (5 800~12 560)×106/L,protein of 35~60 g/L.Pleural effusion culture and (or) blood culture in all cases was positive for MRSA.Chest CT revealed high density lesions in the area of lobar consolicated were found a week later.All cases were treated with vancomycin.After a followed up of more than 6 months,chest CT showed that almost lesions in lungs recovered during 6 months.No cases received pneumonectomy. Conclusions MRSA necrotizing pneumonia is more common in children younger than 3 years old.Pathogenesis of acute and rapid progress,clinically characterized by high fever,coughing and lung tissue necrosis.If diagnosed and treated promptly,the prognosis of MRSA necrotizing pneumonia is relatively well.
Key words
methicillin-resistant staphylococcus aureus /
necrotizing pneumonia /
children
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References
[1] Muileboom J,Hamilton M,Parent K,et al.Community-associated methicillin-resistant Staphylococcus aureus in northwest Ontario:A five-year report of incidence and antibiotic resistance[J].Can J Infect Dis Med Microbiol,2013,24(2):e42-e44.PMID:24421817
[2] Dantes R,Mu Y,Belfolwer R,et al.National burden of invasive methicillin-resistant Staphylococcus aureus infections,United States,2011 [J].JAMA Intern Med,2013,173(21):1970-1978.PMID:24043270
[3] 耐甲氧西林金黄色葡萄球菌感染防治专家委员会.耐甲氧西林金黄色葡萄球菌感染防治专家共识2011年更新版 [J/CD].中华实验和临床感染病杂志:电子版,2011,5(3):372-384.
[4] Hacimustafaoglu M,Celebi S,Sarimehmet H,et al.Necrotizing pneumonia in children[J].Acta Paediatr,2004,93:1172-1177.PMID:15384879
[5] McCarthy VP,Patamasucon P,Gaines T,et al.Necrotizing pneumococcal pneumonia in children[J].Pediatr Pulmonol,1999,28:217-211.PMID:10495339
[6] David MZ,Daum RS.Community-associated methicillin-resistant Staphylococcus aureus:epidemiology and clinical consequences of an emerging epidemic[J].Clin Microbiol Rev,2010,23(3):616-687.PMID:20610826
[7] Ramdani-Bouguessa N,Bes M,Meugnier H,et al.Detection of methicillin-resistant Staphylococcus aureus strains resistant to multiple antibiotics and carrying the Panton-Valentine leukocidin genes in an Algiers hospital [J].Antimicrob Agents Chemother,2006,50(3):1083-1085.PMID:16495247
[8] 赵顺英,钱素云,徐樨巍,等.关注社区获得性肺炎细菌病原的变化[J].中华儿科杂志,2010,48(10):729-732.
[9] Rubinestein E,Kollef MH,Nathwani D.Pneumonia caused by methicillin-resistant Staphylococcus aureus [J].Clin Infect Dis,2008,46(Suppl 5):378-385.PMID:18462093
[10] 刘金荣,徐保平,李惠民,等.肺炎链球菌坏死性肺炎20例诊治分析[J].中华儿科杂志,2012,50(6):431-434.
[11] Hsieh YC,Wang CW,Lai SH,et al.Necrotizing pneumococcal pneumonia with bronchopleural fistula among children in Taiwan[J].Pediatr Infect Dis J,2011,30:740-744.PMID:21852763