Heart Link ECMO Unit, Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Crit Care Med. 2010 Nov;38(11):2250-3. doi: 10.1097/CCM.0b013e3181f26490.
Panton-Valentine leukocidin expressing Staphylococcus aureus pneumonia, an infection that affects predominantly young people, has a mortality rate of > 70% despite aggressive conventional management. Little information is available on the management of patients with Panton-Valentine leukocidin expressing S. aureus pneumonia with extracorporeal membrane oxygenation support. As a large extracorporeal membrane oxygenation center, we reviewed our experience and outcomes with Panton-Valentine Leukocidin expressing S. aureus pneumonia.
Locally held register of all extracorporeal membrane oxygenation patients at Glenfield Hospital.
Retrospective study including all patients with sputum-positive Panton-Valentine leukocidin expressing S. aureus pneumonia managed with extracorporeal membrane oxygenation support at a single extracorporeal membrane oxygenation center.
On review of our database held from September 1989 until date, there were four patients with sputum-confirmed Panton-Valentine leukocidin expressing S. aureus pneumonia managed with extracorporeal membrane oxygenation. Refractory hypoxemia and/or uncompensated hypercapnia despite optimal conventional management were the indications for extracorporeal membrane oxygenation. After varying periods on extracorporeal membrane oxygenation with appropriate antibiotic and ancillary care, all four patients were discharged home.
Panton-Valentine leukocidin expressing S. aureus pneumonia can cause severe, necrotizing pneumonia associated with acute respiratory distress syndrome, which can be particularly challenging to manage. Extracorporeal membrane oxygenation support permits low pressure lung ventilation, avoiding barotrauma to lungs made friable by Panton-Valentine leukocidin expressing S. aureus infection. Although this is a small number of patients, the results are encouraging.
表达潘顿-瓦伦丁白细胞毒素的金黄色葡萄球菌肺炎是一种主要影响年轻人的感染，尽管采用了积极的常规治疗，但死亡率仍超过 70%。关于使用体外膜氧合支持治疗表达潘顿-瓦伦丁白细胞毒素的金黄色葡萄球菌肺炎患者的信息很少。作为一个大型体外膜氧合中心，我们回顾了我们使用表达潘顿-瓦伦丁白细胞毒素的金黄色葡萄球菌肺炎患者的经验和结果。
格伦菲尔德医院所有体外膜氧合患者的本地登记册。
回顾性研究包括在单个体外膜氧合中心接受体外膜氧合支持治疗的痰阳性表达潘顿-瓦伦丁白细胞毒素的金黄色葡萄球菌肺炎患者。
从 1989 年 9 月到目前为止，我们的数据库中回顾了四名痰培养证实为表达潘顿-瓦伦丁白细胞毒素的金黄色葡萄球菌肺炎患者，这些患者接受了体外膜氧合治疗。尽管进行了最佳的常规治疗，但仍存在难治性低氧血症和/或代偿性高碳酸血症是进行体外膜氧合的指征。在接受了不同时间的体外膜氧合治疗，同时使用适当的抗生素和辅助治疗后，所有四名患者均出院回家。
表达潘顿-瓦伦丁白细胞毒素的金黄色葡萄球菌肺炎可引起严重的坏死性肺炎，伴有急性呼吸窘迫综合征，这可能特别难以治疗。体外膜氧合支持允许低压肺通气，避免由表达潘顿-瓦伦丁白细胞毒素的金黄色葡萄球菌感染引起的肺脆弱性导致的气压伤。尽管这是一个少数患者的案例，但结果令人鼓舞。
