Boston Children's Hospital, Department of Emergency Medicine, USA.
Boston Children's Hospital, Department of Emergency Medicine, USA; Boston Children's Hospital, Department of Pediatric Infectious Diseases, USA.
Am J Emerg Med. 2021 Aug;46:34-37. doi: 10.1016/j.ajem.2021.02.055. Epub 2021 Mar 1.
Little is known regarding the differences in microbiology associated with cellulitis or abscess with or without lymphangitic streaking. The objective of our study is to assess whether there are differences in the pathogens identified from wound cultures of patients with paronychia with and without associated lymphangitis.
Retrospective cross-sectional study at a tertiary pediatric emergency department over 25 years. We opted to assess patients with paronychia of the finger, assuming that these cases will have a greater variety of causative pathogens compared to other cases of cellulitis and soft tissue abscess that are associated with nail biting. Case identification was conducted using a computerized text-screening search that was refined by manual chart review. We included patients from 1 month to 20 years of age who underwent an incision and drainage (I&D) of a paronychia and had a culture obtained. The presence or absence of lymphangitis was determined from the clinical narrative in the medical record. We excluded patients treated with antibiotics prior to I&D as well as immune-compromised patients. We used descriptive statistics for prevalence and χ2 tests for categorical variables.
Two hundred sixty-six patients met inclusion criteria. The median age was 9.7 years [IQR 4.7, 15.4] and 45.1% were female. Twenty-two patients (8.3%) had lymphangitic streaking associated with their paronychia. Patients with lymphangitis streaking were similar to those without lymphangitis in terms of age and sex (p = 0.52 and p = 0.82, respectively). Overall, the predominant bacteria was MSSA (40%) followed by MRSA (26%). No significant differences were found between the pathogens in the 22 patients with associated lymphangitis compared to the 244 patients without.
Staphylococcus aureus represent the majority of pathogens in paronychia, although streptococcal species and gram-negative bacteria were also common. Among patients with paronychia of the finger, there seems to be no association between pathogen type and presence of lymphangitic streaking.
关于伴有或不伴有淋巴管炎条纹的蜂窝织炎或脓肿相关微生物的差异知之甚少。我们的研究目的是评估甲沟及其相关淋巴管炎患者的伤口培养物中病原体是否存在差异。
在一家三级儿科急诊部门进行了 25 年的回顾性横断面研究。我们选择评估手指甲沟炎患者，假设与咬指甲相关的其他类型蜂窝织炎和软组织脓肿相比，这些病例会有更多种类的致病病原体。通过计算机文本筛选搜索来识别病例，然后通过手动图表审查进行细化。我们纳入了年龄在 1 个月至 20 岁之间接受甲沟切开引流术 (I&D) 且培养物获得的患者。从病历中的临床描述确定是否存在淋巴管炎。我们排除了在 I&D 之前接受抗生素治疗的患者和免疫功能低下的患者。我们使用描述性统计数据来表示患病率，并使用卡方检验来表示分类变量。
266 名患者符合纳入标准。中位年龄为 9.7 岁 [IQR 4.7, 15.4]，女性占 45.1%。22 名患者 (8.3%) 甲沟伴有淋巴管炎条纹。淋巴管炎条纹患者与无淋巴管炎条纹患者在年龄和性别方面无差异 (p = 0.52 和 p = 0.82)。总体而言，主要细菌是 MSSA(40%)，其次是 MRSA(26%)。在伴有淋巴管炎的 22 名患者与 244 名无淋巴管炎的患者之间，病原体没有发现显著差异。
金黄色葡萄球菌是甲沟炎的主要病原体，尽管链球菌和革兰氏阴性菌也很常见。在手指甲沟炎患者中，病原体类型与淋巴管炎条纹的出现之间似乎没有关联。
