MRSA葡萄球菌烫伤样皮肤综合征的临床特点分析
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摘要
目的探讨耐甲氧西林金黄色葡萄球菌(MRSA)葡萄球菌烫伤样皮肤综合征的临床特点及预后。方法选择医院于2010年1月-2018年6月收治的葡萄球菌烫伤样皮肤综合征患儿180例作为研究对象。所有研究对象进行创面分泌物或咽拭子细菌培养;采用纸片扩散法进行药敏试验。结果 MRSA阳性组发热、口周放射状皲裂和松弛性水疱多于无MRSA阳性组,且有统计学差异(P<0.05);MRSA阳性与无MRSA阳性睑结膜炎、褶皱部红斑糜烂、皮肤触痛和淋巴结肿大比较无统计学差异。MRSA阳性组白细胞上升、心肌酶升高和血液培养阳性高于无MRSA阳性,且有统计学差异(P<0.05)。MRSA药敏试验结果,对青霉素G、红霉素、苯唑西林耐药率较高,而对万古霉素无耐药率。结论 MRSA葡萄球菌烫伤样皮肤综合征的临床上以发热、口周放射状皲裂和松弛性水疱为主,且白细胞上升、心肌酶升高和血液培养阳性,及预后不良。
OBJECTIVE To explore the clinical characteristics and prognosis of methicillin-resistant Staphylococcus aureus(MRSA) scalded skin syndrome. METHODS A total of 180 children with staphylococcal scalded skin syndrome who were treated in hospitals from Jan 2010 to Jun 2018 were recruited as the study objects, the wound secretions and throat swab specimens were collected from all of the study objects and cultured, and the drug susceptibility testing was performed by using disk diffusion method. RESULTS The children who had fever, perioral radial chapped and flaccid blisters were more in the MRSA-positive group than in the MRSA-negative group(P<0.05). There were no significant differences in the eyelid conjunctivitis, erythema erosion in wrinkles, skin tenderness and lymphadenopathy between the MRSA-positive group and the MRSA-negative group. The levels of white blood cells and myocardial enzymes as well as positive rate of blood culture were significantly higher in the MRSA-positive group than in the MRSA-negative group(P<0.05). The result of drug susceptibility testing showed that the drug resistance rates to penicillin G, erythromycin and oxacillin were high, while the drug resistance rate to vancomycin was 0. CONCLUSION Fever, perioral radial chapped and flaccid blisters are the major clinical manifestations of the children with MRSA staphylococcal scalded skin syndrome, the levels of white blood cells, myocardial enzymes and positive rate of blood culture are high, and the children have unfavorable prognosis.
OBJECTIVE To explore the clinical characteristics and prognosis of methicillin-resistant Staphylococcus aureus(MRSA) scalded skin syndrome. METHODS A total of 180 children with staphylococcal scalded skin syndrome who were treated in hospitals from Jan 2010 to Jun 2018 were recruited as the study objects, the wound secretions and throat swab specimens were collected from all of the study objects and cultured, and the drug susceptibility testing was performed by using disk diffusion method. RESULTS The children who had fever, perioral radial chapped and flaccid blisters were more in the MRSA-positive group than in the MRSA-negative group(P<0.05). There were no significant differences in the eyelid conjunctivitis, erythema erosion in wrinkles, skin tenderness and lymphadenopathy between the MRSA-positive group and the MRSA-negative group. The levels of white blood cells and myocardial enzymes as well as positive rate of blood culture were significantly higher in the MRSA-positive group than in the MRSA-negative group(P<0.05). The result of drug susceptibility testing showed that the drug resistance rates to penicillin G, erythromycin and oxacillin were high, while the drug resistance rate to vancomycin was 0. CONCLUSION Fever, perioral radial chapped and flaccid blisters are the major clinical manifestations of the children with MRSA staphylococcal scalded skin syndrome, the levels of white blood cells, myocardial enzymes and positive rate of blood culture are high, and the children have unfavorable prognosis.
引文
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[14] Bari SMN,Walker FC,Cater K,et al.Strategies for editing virulent staphylococcal phages using CRISPR-Cas10[J].ACS Synth Biol,2017,6(12):2316-2325.
[15] Munoz-Gallego I,Lora-Tamayo J,Pérez-Montarelo D,et al.Influence of molecular characteristics in the prognosis of methicillin-resistant Staphylococcus aureus prosthetic joint infections:beyond the species and the antibiogram[J].Infection,2017,45(4):533-537.
[16] Sharma H,Smith D,Turner CE,et al.Clinical and molecular epidemiology of staphylococcal toxic shock syndrome in the United Kingdom[J].Emerg Infect Dis,2018,24(2):258-266.
[17] 张永宁,刘平定.儿童葡萄球菌烫伤样皮肤综合征46例临床分析[J].中国妇幼健康研究,2016,27(4):515-517.
[18] 王红兰,黄艳丽,庄永灿,等.葡萄球菌性烫伤样皮肤综合征35例分析[J].中国中西医结合皮肤性病学杂志,2017,16(1):55-57.
[19] 朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.
[20] Victorelli FD,Calixto GMF,Ramos MADS,et al.Metronidazole-loaded polyethyleneimine and chitosan-based liquid crystalline system for treatment of staphylococcal skin infections[J].J Biomed Nanotechnol,2018,14(1):227-237.
[21] 韦祝,刘向宇,罗勇奇,等.374例金黄色葡萄球菌烫伤样皮肤综合征患儿病原菌及其药敏试验结果[J].中国药师,2016,19(6):1099-1101.
[2] Leung AKC,Barankin B,Leong KF.Staphylococcal-scalded skin syndrome:evaluation,diagnosis,and management[J].World J Pediatr,2018,14(2):116-120.
[3] Ajmi H,Jemmali N,Mabrouk S,et al.Staphylococcal scalded skin syndrome:an uncommon symptomatology revealing an immunedeficiency[J].Arch Pediatr,2018,25(2):126-128.
[4] Urata T,Kono M,Ishihara Y,et al.Adult staphylococcal scalded skin syndrome successfully treated with multimodal therapy including intravenous immunoglobulin[J].Acta Derm Venereol,2018,98(1):136-137.
[5] 慕珍珍,崔丽霞,韩秀萍.儿童金黄色葡萄球菌烫伤样皮肤综合征228例临床分析[J].中国皮肤性病学杂志,2018,33(2):175-178.
[6] Davidson J,Polly S,Hayes PJ,et al.Recurrent staphylococcal scalded skin syndrome in an extremely low-birth-weight neonate[J].AJP Rep,2017,7(2):e134-e137.
[7] 中华人民共和国卫生部医政司.全国临床检验操作规程[M].南京:东南大学出版社,1991:1-5.
[8] Haasnoot PJ,De Vries A.Staphylococcal scalded skin syndrome in a 4-year-old child:a case report[J].J Med Case Rep,2018,12(1):20.
[9] Eginli A,Shah K,Watkins C,et al.Stevens-Johnson syndrome and toxic epidermal necrolysis[J].Ann Allergy Asthma Immunol,2017,118(2):143-147.
[10] 马琳.金葡菌烫伤样皮肤综合征[J].中国实用儿科学,2001,16(11):648-652.
[11] Wiedemann K,Schmid C,Hamm H,et al.Staphylococcal scalded skin syndrome in a very low birth weight premature infant[J].Z Geburtshilfe Neonatol,2016,220(1):35-38.
[12] Horner A,Horner R,Salla A,et al.Staphylococcal scalded skin syndrome in a premature newborn caused by methicillin-resistant Staphylococcus aureus:case report[J].Sao Paulo Med J,2015,133(5):450-453.
[13] Ajmi H,Jemmali N,Mabrouk S,et al.Staphylococcal scalded skin syndrome:an uncommon symptomatology revealing an immunedeficiency[J].Arch Pediatr,2018,25(2):126-128.
[14] Bari SMN,Walker FC,Cater K,et al.Strategies for editing virulent staphylococcal phages using CRISPR-Cas10[J].ACS Synth Biol,2017,6(12):2316-2325.
[15] Munoz-Gallego I,Lora-Tamayo J,Pérez-Montarelo D,et al.Influence of molecular characteristics in the prognosis of methicillin-resistant Staphylococcus aureus prosthetic joint infections:beyond the species and the antibiogram[J].Infection,2017,45(4):533-537.
[16] Sharma H,Smith D,Turner CE,et al.Clinical and molecular epidemiology of staphylococcal toxic shock syndrome in the United Kingdom[J].Emerg Infect Dis,2018,24(2):258-266.
[17] 张永宁,刘平定.儿童葡萄球菌烫伤样皮肤综合征46例临床分析[J].中国妇幼健康研究,2016,27(4):515-517.
[18] 王红兰,黄艳丽,庄永灿,等.葡萄球菌性烫伤样皮肤综合征35例分析[J].中国中西医结合皮肤性病学杂志,2017,16(1):55-57.
[19] 朱吉超,魏莲花,杨永清,等.耐甲氧西林金黄色葡萄球菌临床分布及耐药性分析[J].中华医院感染学杂志,2017,27(7):1462-1465.
[20] Victorelli FD,Calixto GMF,Ramos MADS,et al.Metronidazole-loaded polyethyleneimine and chitosan-based liquid crystalline system for treatment of staphylococcal skin infections[J].J Biomed Nanotechnol,2018,14(1):227-237.
[21] 韦祝,刘向宇,罗勇奇,等.374例金黄色葡萄球菌烫伤样皮肤综合征患儿病原菌及其药敏试验结果[J].中国药师,2016,19(6):1099-1101.