Seal John, Glynn Loretto, Statter Mindy, Liu Donald
University of Chicago Pritzker School of Medicine, Chicago, IL 60632, USA.
Pediatr Surg Int. 2006 Aug;22(8):683-7. doi: 10.1007/s00383-006-1684-x. Epub 2006 Jul 8.
Over the past decade, methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a global problem, prompting extensive surveillance efforts. A previous study of S. aureus isolates at our institution revealed alarming increases in the prevalence of MRSA with no sign of plateau. However, evidence of MRSA in pediatric surgical patients remains largely anecdotal, as there are no published reports of institutional MRSA surveillance in the pediatric surgical literature. We conducted a retrospective review of incision and drainage (I and D) procedures at our institution from 1998 through 2004. All I and D procedures performed at the University of Chicago Children's Hospital were identified and the patients' charts reviewed for pertinent information. A total of 99 I and D procedures were performed during the study period, ranging from 5 in 1998 to 32 in 2004. Among cultures with positive growth, 52 (65.8%) were MRSA, 14 (17.7%) were methicillin-sensitive S. aureus, and 13 (16.5%) were miscellaneous species. The number of MRSA isolates increases from 2 in 1998 to 20 in 2004, the largest increase occurring during the last 3 years of the study. A large proportion of MRSA isolates were resistant to antimicrobials from other classes, with over 70% being resistant to both erythromycin and cefazolin. A majority of MRSA isolates (71.4%) were obtained from patients with no record of prior hospitalization. Our analysis confirms a high prevalence of MRSA among soft-tissue infections requiring surgical drainage. In addition, a majority of MRSA isolates were resistant to multiple antimicrobials and were isolated from children without a previous documented exposure to the hospital milieu. Thus, pediatric surgeons should be aware of MRSA prevalence and resistance patterns in the local communities.
在过去十年中，耐甲氧西林金黄色葡萄球菌（MRSA）已成为一个全球性问题，促使人们展开广泛的监测工作。我们机构之前对金黄色葡萄球菌分离株的一项研究显示，MRSA的患病率惊人地上升，且没有趋于平稳的迹象。然而，儿科手术患者中MRSA的证据在很大程度上仍只是传闻，因为儿科手术文献中没有关于机构MRSA监测的已发表报告。我们对1998年至2004年期间我们机构的切开引流（I和D）手术进行了回顾性研究。确定了在芝加哥大学儿童医院进行的所有I和D手术，并查阅患者病历以获取相关信息。在研究期间共进行了99例I和D手术，从1998年的5例到2004年的32例不等。在培养结果呈阳性生长的样本中，52例（65.8%）为MRSA，14例（17.7%）为甲氧西林敏感金黄色葡萄球菌，13例（16.5%）为其他菌种。MRSA分离株的数量从1998年的2例增加到2004年的20例，最大增幅出现在研究的最后三年。很大一部分MRSA分离株对其他类别的抗菌药物耐药，超过70%对红霉素和头孢唑林均耐药。大多数MRSA分离株（71.4%）来自无既往住院记录的患者。我们的分析证实，在需要手术引流的软组织感染中，MRSA的患病率很高。此外，大多数MRSA分离株对多种抗菌药物耐药，且是从之前没有记录显示接触过医院环境的儿童中分离出来的。因此，儿科外科医生应了解当地社区中MRSA的患病率和耐药模式。
