Fortunov Regine M, Hulten Kristina G, Hammerman Wendy A, Mason Edward O, Kaplan Sheldon L
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Pediatrics. 2007 Nov;120(5):937-45. doi: 10.1542/peds.2007-0956.
We describe the evaluation and treatment of neonatal community-acquired Staphylococcus aureus disease in the era of community-acquired methicillin-resistant S. aureus.
We retrospectively reviewed the evaluation and treatment of 126 community-acquired S. aureus infections of term and late-preterm previously healthy neonates who were < or = 30 days of age between August 2001 and July 2006 at Texas Children's Hospital.
S. aureus infections included 43 pustulosis, 68 cellulitis/abscess, and 15 invasive infections. We found 84 methicillin-resistant and 42 methicillin-susceptible S. aureus isolates. Twenty-one patients received outpatient antibiotics before hospital presentation. Systemic infection evaluation included urine, blood, and cerebrospinal fluid cultures in 79, 102, and 84 neonates, respectively. Culture revealed S. aureus urinary tract infections in 1, S. aureus bacteremias in 6, and aseptic cerebrospinal fluid pleocytosis of unclear cause in 11 neonates. Physicians admitted 106, transferred 5 to other hospitals, and discharged 15 afebrile patients with topical or oral antibiotics. Clindamycin was the predominant antistaphylococcal intravenous and oral antibiotic for pustulosis and cellulitis/abscess infections. One patient with systemic S. aureus and herpes simplex virus infection died. At discharge after inpatient treatment, physicians prescribed no antibiotics for 43 patients and oral or topical antibiotics for 62 patients. Outpatient treatment failed for 1 patient who was discharged after intravenous therapy and was readmitted. Eighty percent (16 of 20) of patients with mastitis alone completed treatment with outpatient oral antibiotics.
Evaluation and treatment strategies for neonatal community-acquired S. aureus disease are varied at our hospital. Prospective studies are needed to determine optimal management strategies.
我们描述了在社区获得性耐甲氧西林金黄色葡萄球菌时代新生儿社区获得性金黄色葡萄球菌病的评估与治疗。
我们回顾性分析了2001年8月至2006年7月在德克萨斯儿童医院收治的126例胎龄足月和近足月、先前健康、年龄小于或等于30天的社区获得性金黄色葡萄球菌感染新生儿的评估与治疗情况。
金黄色葡萄球菌感染包括43例脓疱病、68例蜂窝织炎/脓肿和15例侵袭性感染。我们发现84株耐甲氧西林金黄色葡萄球菌和42株甲氧西林敏感金黄色葡萄球菌分离株。21例患者在入院前接受了门诊抗生素治疗。全身感染评估分别包括对79例、102例和84例新生儿进行尿液、血液和脑脊液培养。培养结果显示1例新生儿为金黄色葡萄球菌尿路感染，6例为金黄色葡萄球菌败血症，11例新生儿原因不明的无菌性脑脊液细胞增多。106例患者入院治疗，5例转至其他医院，15例体温正常的患者接受局部或口服抗生素后出院。克林霉素是脓疱病和蜂窝织炎/脓肿感染的主要抗葡萄球菌静脉和口服抗生素。1例患有全身性金黄色葡萄球菌和单纯疱疹病毒感染的患者死亡。住院治疗出院时，43例患者未使用抗生素，62例患者使用口服或局部抗生素。1例静脉治疗后出院的患者再次入院，门诊治疗失败。仅患乳腺炎的患者中，80%（20例中的16例）完成了门诊口服抗生素治疗。
我院新生儿社区获得性金黄色葡萄球菌病的评估和治疗策略各不相同。需要进行前瞻性研究以确定最佳管理策略。
