Jung N, Lehmann C, Hellmann M, Seifert H, Valter M M, Hallek M, Fätkenheuer G, Kochanek M
Department I of Internal Medicine, University of Cologne, 50935 Cologne, Germany.
Infect Dis Obstet Gynecol. 2008;2008:491401. doi: 10.1155/2008/491401.
Panton-Valentine leukocidin (PVL-)producing Staphylococcus aureus is emerging as a serious problem worldwide. There has been an increase in the incidence of necrotizing lung infections in otherwise healthy young people with a very high mortality associated with these strains. Sporadic severe infectious complications after incision of Bartholin's abcesses have been described but involvement of S. aureus is rare.
We present a 23-year-old apparently healthy female patient without any typical predisposing findings who developed severe sepsis with necrotizing pneumonia and multiple abscesses following incision of a Bartholin's abscess. Methicillin-sensitive S. aureus harbouring Panton-Valentine leucocidin genes were cultured from the abscess fluid, multiple blood cultures and a postoperative wound swab. Aggressive antibiotic therapy with flucloxacillin, rifampicin and clindamycin, drainage and intensive supportive care lead finally to recovery.
S. aureus, in particular PVL-positive strains, should be considered when a young, immunocompetent person develops a fulminant necrotizing pneumonia. Minor infections--such as Bartholin's abscess--can precede this life-threating syndrome. Bactericidal antistaphylococcal antibiotics are recommended for treatment, and surgical procedures may become necessary.
产杀白细胞素（PVL）的金黄色葡萄球菌正在成为全球范围内的一个严重问题。在原本健康的年轻人中，坏死性肺部感染的发病率有所上升，且与这些菌株相关的死亡率非常高。巴氏腺脓肿切开术后偶发严重感染并发症的情况已有描述，但金黄色葡萄球菌感染罕见。
我们报告一名23岁看似健康的女性患者，无任何典型的易感因素，在巴氏腺脓肿切开术后发生了伴有坏死性肺炎和多处脓肿的严重脓毒症。从脓肿液、多次血培养及术后伤口拭子中培养出携带杀白细胞素基因的甲氧西林敏感金黄色葡萄球菌。联合使用氟氯西林、利福平和克林霉素进行积极的抗生素治疗、引流及强化支持治疗最终使患者康复。
当一名年轻、免疫功能正常的人发生暴发性坏死性肺炎时，应考虑金黄色葡萄球菌感染，尤其是PVL阳性菌株。轻微感染，如巴氏腺脓肿，可能先于这种危及生命的综合征出现。建议使用杀菌性抗葡萄球菌抗生素进行治疗，且可能需要采取手术措施。
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