Citla Sridhar Divyaswathi, Maher Ossama M, Rodriguez Nidra I
Department of Pediatric Hematology Oncology, Case Western Reserve University School of Medicine, Cleveland, OH.
Department of Pediatric Hematology Oncology, Nicklaus Children's Hospital, Miami, FL.
J Pediatr Hematol Oncol. 2018 Mar;40(2):e73-e76. doi: 10.1097/MPH.0000000000001040.
Deep venous thrombosis (DVT) has been previously reported in children with methicillin-resistant Staphylococcus aureus (MRSA). This study reviews our institutional experience by evaluating characteristics and outcomes of children with DVT and staphylococcal infections. Retrospective clinical data from 16 pediatric patients with DVT and staphylococcal infections over a 5-year period was obtained via medical record abstraction. Sixteen patients with a median age at diagnosis of 8 years were included. The most common infection encountered was osteomyelitis (56%). The most common isolated organism was MRSA (63%). Central venous catheters were present in 50% of cases. All patients received anticoagulation with low molecular weight heparin except 1 patient with superficial venous thrombosis who was managed conservatively. Fifty percent of patients had complete resolution of DVT by the end of treatment, 25% of the patients had early disappearance of the thrombus at 7 to 10 days. Only 2 patients (12.5%) had persistent thrombus at 6 months. Staphylococcal infections may increase the risk of DVT in children. Therefore, a high index of suspicion for DVT is warranted in children with Staphylococcal infections (particularly MRSA) to promptly diagnose, treat and minimize complications. Prophylactic anticoagulation in presence of staphylococcal infection, particularly MRSA, may be considered in future studies.
此前已有关于耐甲氧西林金黄色葡萄球菌（MRSA）感染儿童发生深静脉血栓形成（DVT）的报道。本研究通过评估DVT合并葡萄球菌感染患儿的特征及转归，回顾了我们机构的经验。通过病历摘要获取了16例5年间患有DVT合并葡萄球菌感染的儿科患者的回顾性临床数据。纳入了16例诊断时中位年龄为8岁的患者。最常见的感染是骨髓炎（56%）。最常见的分离菌是MRSA（63%）。50%的病例存在中心静脉导管。除1例浅表静脉血栓形成患者采用保守治疗外，所有患者均接受低分子量肝素抗凝治疗。50%的患者在治疗结束时DVT完全消退，25%的患者在7至10天时血栓早期消失。只有2例患者（12.5%）在6个月时仍有持续性血栓。葡萄球菌感染可能会增加儿童发生DVT的风险。因此，对于葡萄球菌感染（尤其是MRSA）的儿童，有必要高度怀疑DVT，以便及时诊断、治疗并将并发症降至最低。在未来的研究中，可考虑对存在葡萄球菌感染（尤其是MRSA）的患者进行预防性抗凝治疗。
