Sifuentes-Osornio José, Pérez-Patrigeon Santiago
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF.
Rev Invest Clin. 2006 Nov-Dec;58(6):598-607.
Clinical case. This 27 year-old male was referred admitted with severe acute pancreatitis (SAP) after heavy consumption of alcohol and sepsis (bacteremia and multilobar pneumonia) due to methicillin-resistant Staphylococcus aureus (MRSA); he required mechanical ventilation and haemodyalisis, and developed fungemia by fluconazol-resistant Candida albicans. He was treated with caspofungin for 20 days and vancomycin for six weeks, and he was discharged after 51 days of hospitalization. This case shows the painful evolution of a patient admitted to the intensive care unit (ICU) with MRSA sepsis. According to the National Nosocomial Infections Study (USA), S. aureus is the cause of up to 35% of hospital-acquired pneumonia and bacteremia. Using molecular tools (e.g. pulse gel electrophoresis), different families of MRSA have been well described. Use of i.v. catheters, long-term hospitalization, surgery and previous use of antimicrobials are considered major risk factors for MRSA. In Mexico, Alpuche-Aranda, et al (1986) reported a prevalence of 5% in a pediatric hospital. However, a recent report from the National Resistance Network showed a MRSA prevalence of 36% in 2004. In this institution, we observed a rate of MRSA of 100% in the ICU during 2005. This case shows an episode of SAP after heavy alcohol consumption, complicated with severe infections such as candidemia and MRSA sepsis; fortunately he had a favorable outcome after a multidisciplinary and aggressive approach. This case fulfilled all the risk factors for an MRSA infection, in a setting with a very high rate of methicillin-resistance, which compels the medical community to implement adequate and efficacious epidemiological control measures.
临床病例。该27岁男性因大量饮酒后发生重症急性胰腺炎（SAP）以及耐甲氧西林金黄色葡萄球菌（MRSA）所致的脓毒症（菌血症和多叶肺炎）入院；他需要机械通气和血液透析，并发生了耐氟康唑白色念珠菌所致的真菌血症。他接受了卡泊芬净治疗20天和万古霉素治疗六周，住院51天后出院。本病例显示了一名入住重症监护病房（ICU）的患者发生MRSA脓毒症的痛苦病程。根据美国国家医院感染研究，金黄色葡萄球菌是高达35%的医院获得性肺炎和菌血症的病因。使用分子工具（如脉冲凝胶电泳），已对不同家族的MRSA进行了充分描述。静脉留置导管的使用、长期住院、手术以及先前使用抗菌药物被认为是MRSA的主要危险因素。在墨西哥，阿尔普切 - 阿兰达等人（1986年）报告一家儿科医院的患病率为5%。然而，国家耐药性监测网络最近的一份报告显示，2004年MRSA的患病率为36%。在本机构，我们观察到2005年ICU中MRSA的发生率为100%。本病例显示了大量饮酒后发生的SAP发作，并伴有念珠菌血症和MRSA脓毒症等严重感染；幸运的是，经过多学科积极治疗，他获得了良好的预后。本病例具备了MRSA感染的所有危险因素，所处环境中甲氧西林耐药率非常高，这迫使医学界实施充分有效的流行病学控制措施。
