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产后女性的耐甲氧西林金黄色葡萄球菌乳腺脓肿

MRSA breast abscesses in postpartum women.

作者信息

Chuwa E W L, Wong C M Y, Tan Y Y, Hong G S

机构信息

Breast Unit, KK Women's and Children's Hospital, Singapore.

出版信息

Asian J Surg. 2009 Jan;32(1):55-8. doi: 10.1016/S1015-9584(09)60010-5.

Abstract

BACKGROUND

Infections caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are being increasingly observed in patients who lack traditional risk factors. While mastitis and breast abscesses are commonly encountered in post-natal women, CA-MRSA breast infections have rarely been reported.

MATERIALS AND METHODS

We reviewed 15 postpartum women with methicillin-resistant Staphylococcus aureus (MRSA) breast abscesses observed in our unit from June 2005 to April 2007. Ultrasonographic examination was performed in all cases. MRSA infection was diagnosed on microbiological analysis cultured from the abscesses of these patients.

RESULTS

The median age of the patients was 31.5 years. The majority of the patients were primiparae (80%). Only one patient was immunocompromised. None of the patients had history of previous breast infection and none developed recurrence. Eleven patients (73.3%) underwent aspiration of pus and four patients (26.7%) underwent incision and drainage. All the cultures were sensitive to co-trimoxazole and vancomycin. Eight (53.3%) of the cultures were also sensitive to erythromycin.

CONCLUSION

CA-MRSA is an emerging problem in our obstetric population. CA-MRSA breast infections are clinically responsive to common oral antibiotics such as co-trimoxazole and erythromycin. A high index of suspicion is essential to avoid delay in the clinical response to empirical beta-lactams as these patients may benefit from an early change of antibiotics.

摘要

背景

在缺乏传统风险因素的患者中,社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)引起的感染越来越常见。虽然乳腺炎和乳腺脓肿在产后女性中很常见,但CA-MRSA引起的乳腺感染鲜有报道。

材料与方法

我们回顾了2005年6月至2007年4月在我们科室观察到的15例患有耐甲氧西林金黄色葡萄球菌(MRSA)乳腺脓肿的产后女性。所有病例均进行了超声检查。通过对这些患者脓肿培养物进行微生物分析诊断出MRSA感染。

结果

患者的中位年龄为31.5岁。大多数患者为初产妇(80%)。只有1例患者免疫功能低下。所有患者既往均无乳腺感染史,也均未复发。11例患者(73.3%)进行了抽脓,4例患者(26.7%)进行了切开引流。所有培养物对复方新诺明和万古霉素敏感。8份培养物(53.3%)对红霉素也敏感。

结论

CA-MRSA在我们的产科人群中是一个新出现的问题。CA-MRSA引起的乳腺感染对复方新诺明和红霉素等常见口服抗生素有临床反应。高度怀疑对于避免对经验性β-内酰胺类抗生素的临床反应延迟至关重要,因为这些患者可能从早期更换抗生素中获益。

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