Martini Silvia, Tumietto Fabio, Sciutti Rita, Greco Laura, Faldella Giacomo, Corvaglia Luigi
Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Infectious Diseases Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Ital J Pediatr. 2015 Aug 4;41:54. doi: 10.1186/s13052-015-0163-1.
Methicillin-resistant Staphylococcus aureus (MRSA) is an established nosocomial pathogen with frequent multidrug resistance. The immaturity of the immune system along with intravascular lines and empirical antibiotic treatments place hospitalized preterm infants at major risk of MRSA infection.We report a case of MRSA mandibular osteomyelitis complicating a persistent S. aureus bacteremia in a 23-week preterm infant. From the first weeks of life, the infant showed recurrent C-reactive protein (CRP) elevation, associated with S. aureus bacteremia. Antibiotic courses, including vancomycin and linezolid, were performed with transitory normalization of blood parameters. On day 74, the infant suddenly deteriorated and showed a significant increase of both CRP and procalcitonin. Empiric vancomycin and piperacillin-tazobactam treatment was started; nevertheless, she developed a progressive hard swelling of neck and mandible. Radiological evaluation revealed a mandibular osteomyelitis complicated by an abscess, whose culture grew MRSA. Vancomycin was thus changed to teicoplanin and complete clinical and radiological healing was gradually achieved.In the presence of major risk factors, persistent bacteremia and nonspecific symptoms, a localized focus of infection should be suspected. Microbiological diagnosis should always be attempted and antibiotic treatment should be guided by both susceptibility results and clinical response.
耐甲氧西林金黄色葡萄球菌（MRSA）是一种常见的具有多重耐药性的医院病原体。免疫系统不成熟、血管内留置导管以及经验性抗生素治疗使住院早产儿面临MRSA感染的重大风险。我们报告一例23周早产儿发生MRSA下颌骨骨髓炎，并发持续性金黄色葡萄球菌菌血症。从出生后的最初几周起，该婴儿就出现反复的C反应蛋白（CRP）升高，与金黄色葡萄球菌菌血症相关。使用包括万古霉素和利奈唑胺在内的抗生素疗程后，血液参数暂时恢复正常。在第74天，婴儿突然病情恶化，CRP和降钙素原均显著升高。开始经验性使用万古霉素和哌拉西林-他唑巴坦治疗；然而，她出现了颈部和下颌骨进行性硬肿胀。影像学评估显示下颌骨骨髓炎并发脓肿，其培养物培养出MRSA。因此将万古霉素改为替考拉宁，逐渐实现了临床和影像学的完全愈合。在存在主要危险因素、持续性菌血症和非特异性症状的情况下，应怀疑有局部感染灶。应始终尝试进行微生物学诊断，抗生素治疗应以药敏结果和临床反应为指导。
