Patrick C C, Kaplan S L, Baker C J, Parisi J T, Mason E O
Myers-Black Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas.
Pediatrics. 1989 Dec;84(6):977-85.
During a 6-month period in 1987, 13 low birth weight neonates without indwelling central intravascular catheters had persistent (positive blood cultures for greater than or equal to 6 days) coagulase-negative staphylococcal bacteremia despite adequate antibiotic therapy. Daily blood cultures remained persistently positive for a mean of 13 days (range 6 to 25 days). This group of infants was compared with other low birth weight infants with similar birth weights and nonpersistent coagulase-negative staphylococcal bacteremia, defined as two or more positive blood cultures accompanied by supporting clinical manifestations of sepsis. During this period, coagulase-negative staphylococcal represented 29% of all bacteremias, and 33% of coagulase-negative staphylococcal bacteremias were persistent. Other than soft tissue abscesses, none of the infants with persistent coagulase-negative staphylococcal bacteremia had a defined focus of infection. Abdominal distention (P = .001) and thrombocytopenia (P less than .03) occurred significantly more frequently in the patients with persistent coagulase-negative staphylococcal bacteremia than in those with nonpersistent bacteremia. Of the 13 patients with persistent coagulase-negative staphylococcal bacteremia, 2 received methicillin and 11 received vancomycin. No antibiotic tolerance to either antibiotic could be demonstrated. Serum concentrations of vancomycin far exceeded the minimum bactericidal concentration in all cases in which vancomycin was prescribed. No in vitro differences could be demonstrated between persistent and nonpersistent coagulase-negative staphylococcal strains for slime production, biotype, proteins from modified whole cell lysates developed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and opsonophagocytosis by adult neutrophils in the presence of pooled human sera. Additionally, plasmid profile analysis and phage typing revealed no common strain causing the persistent bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
1987年的6个月期间，13名未留置中心血管内导管的低体重新生儿，尽管接受了充分的抗生素治疗，仍发生了持续性（血培养阳性≥6天）凝固酶阴性葡萄球菌菌血症。每日血培养持续阳性，平均持续13天（范围6至25天）。将这组婴儿与其他出生体重相似、发生非持续性凝固酶阴性葡萄球菌菌血症的低体重婴儿进行比较，后者定义为两次或更多次血培养阳性并伴有败血症的支持性临床表现。在此期间，凝固酶阴性葡萄球菌占所有菌血症的29%，其中33%为持续性菌血症。除软组织脓肿外，持续性凝固酶阴性葡萄球菌菌血症的婴儿均无明确的感染灶。持续性凝固酶阴性葡萄球菌菌血症患者出现腹胀（P = 0.001）和血小板减少（P<0.03）的频率明显高于非持续性菌血症患者。13例持续性凝固酶阴性葡萄球菌菌血症患者中，2例接受了甲氧西林治疗，11例接受了万古霉素治疗。未发现对这两种抗生素有耐药性。在所有使用万古霉素的病例中，血清万古霉素浓度均远远超过最低杀菌浓度。持续性和非持续性凝固酶阴性葡萄球菌菌株在黏液产生、生物型、经十二烷基硫酸钠-聚丙烯酰胺凝胶电泳处理的改良全细胞裂解物中的蛋白质以及在合并人血清存在下成年中性粒细胞的调理吞噬作用方面，未发现体外差异。此外，质粒图谱分析和噬菌体分型显示，没有共同菌株导致持续性菌血症。（摘要截断于250字）
