Servicio de Infectología, Hospital de Niños Víctor J. Vilela de Rosario.
Centro Rosarino de Estudios Perinatales (CREP).
Arch Argent Pediatr. 2021 Feb;119(1):11-17. doi: 10.5546/aap.2021.eng.11.
Community-acquired methicillinresistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CAMRSA necrotizing pneumonia and empyema are now more common in children.
To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.
Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).
Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CAMRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32- 16.38) and admission to the ICU (RR: 4.29; 2.70- 6.83). No patient died due to SP pneumonia.
The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement.
近年来，社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染有所增加。CAMRSA 坏死性肺炎和脓胸在儿童中更为常见。
确定 CA-MRSA 肺炎的患病率，并与同一人群中的肺炎链球菌（SP）肺炎相比，确定其临床和流行病学特征。
对 2008 年 1 月至 2017 年 12 月期间因 CA-MRSA 肺炎住院的患者进行描述性、观察性、横断面研究。
在 54 例金黄色葡萄球菌肺炎病例中，46 例（85%）为 CA-MRSA。CA-MRSA 肺炎的发生率从 2008 年的每 10000 人 4.9 例（每 10000 人 4.9 例）到 2017 年的每 10000 人 10 例。41%的患者发生败血症/感染性休克；96%的患者发生脓胸；35%的患者发生气胸；90%的患者需要胸腔引流，55%的患者需要手术清创。此外，65%的患者入住重症监护病房（ICU）；其中一半需要辅助机械通气。有 2 例患者死亡。耐药性：17%，庆大霉素；13%，红霉素；11%，克林霉素。与 SP 肺炎相比，CAMRSA 肺炎发生败血症的风险更高（95%置信区间；相对风险：7.38；3.32-16.38），入住 ICU 的风险更高（RR：4.29；2.70-6.83）。没有因 SP 肺炎而死亡的患者。
在过去十年中，CA-MRSA 肺炎的患病率翻了一番。与 SP 肺炎相比，CA-MRSA 肺炎更常伴有败血症和感染性休克、入住 ICU 和需要呼吸机支持。
