Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess.
Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess.
复制标题
小儿纵隔炎是耐甲氧西林金黄色葡萄球菌咽后脓肿的并发症。
DOI：
10.1001/archotol.134.4.408
复制
发表时间：
2008
期刊：
影响因子：
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通讯作者：
H. Gould
中科院分区：
文献类型：
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作者：
C. T. Wright;R. Stocks;David L Armstrong;S. Arnold;H. Gould
目标
检查 8 年来咽后感染 (RPI) 的发病率、细菌学和并发症的变化。
设计
回顾性病历审查。
设置
三级儿童医院。
患者
研究人群包括 108 名 18 岁以下的患者。
干预
对出院诊断为 RPI 的患者进行病历审查（国际疾病分类，第九版修订代码 478.24）。
主要成果指标
将1997年6月至2001年5月的病例与2001年6月至2005年5月的病例进行比较，以检查RPI的发病率、细菌学和并发症的变化。
结果
过去 4 年里，RPI 病例数量翻了一番，从 36 起增至 72 起。最初4年，未发现耐甲氧西林金黄色葡萄球菌（MRSA）分离株，1例患者出现纵隔炎。近4年，25例培养阳性患者中，有8例（32%）分离出MRSA，并有7例发生纵隔炎。在 8 名 MRSA 培养呈阳性的儿童中，有 6 名患有纵隔炎。所有患有 RPI 的儿童的中位年龄为 32.5 个月 (n = 108)。患有 MRSA 和纵隔炎的儿童的中位年龄分别为 6.5 个月 (n = 8) 和 5.5 个月 (n = 8)。
结论
过去 4 年里，RPI 病例数量出现了惊人的增长。耐甲氧西林金黄色葡萄球菌现在是我们机构 RPI 患者的重要病原体。有记录的社区相关 MRSA 感染的局部增加和对克林霉素的普遍敏感性表明，社区相关 MRSA 是细菌学变化的原因。 MRSA 感染与纵隔炎之间存在高度相关性。 MRSA 感染患者年龄较小，由于免疫系统不成熟，可能容易患纵隔炎。对于 MRSA 需要有更高的怀疑指数，特别是对于 1 岁以下的患者。
OBJECTIVE
To examine changes in the incidence, bacteriology, and complications of retropharyngeal infection (RPI) over an 8-year period.
DESIGN
Retrospective medical record review.
SETTING
Tertiary children's hospital.
PATIENTS
The study population comprised 108 patients younger than 18 years old.
INTERVENTION
Medical record review of patients with a discharge diagnosis of RPI (International Classification of Diseases, Ninth Revision code 478.24).
MAIN OUTCOME MEASURES
Cases from June 1997 to May 2001 were compared with those from June 2001 to May 2005 to examine changes in the incidence, bacteriology, and complications of RPI.
RESULTS
The number of RPI cases doubled from 36 to 72 in the final 4 years. In the first 4 years, no isolates of methicillin-resistant Staphylococcus aureus (MRSA) were found, and 1 patient developed mediastinitis. In the last 4 years, 8 of 25 patients (32%) with positive cultures had MRSA isolated, and 7 cases of mediastinitis occurred. Of the 8 children with cultures positive for MRSA, 6 developed mediastinitis. The median age for all children with RPI was 32.5 months (n = 108). The median age for children with MRSA and mediastinitis was 6.5 months (n = 8) and 5.5 months (n = 8), respectively.
CONCLUSIONS
An alarming increase in the number of RPI cases occurred over the final 4 years. Methicillin-resistant S aureus is now a significant pathogen in patients with RPI at our institution. Documented local increases in community-associated MRSA infections and universal sensitivity to clindamycin suggest that community-associated MRSA is responsible for the change in bacteriology. A high correlation exists between MRSA infection and mediastinitis. Patients with MRSA infections are younger and may be vulnerable to developing mediastinitis because of immature immune systems. A higher index of suspicion is needed for MRSA, especially in patients younger than 1 year.
Naomi Oyama、Shihoko Nomura：“尝试在护理中运用护理和接触伦理”普通护理 34(4) (1999)。
DOI：
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发表时间：
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期刊：
影响因子：
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作者：
通讯作者：
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影响因子：
120.7
作者：
Herold, BC;Immergluck, LC;Daum, RS
通讯作者：
Daum, RS