Community associated methicillin resistant Staphylococcal infections in a pediatric urology practice
Community associated methicillin resistant Staphylococcal infections in a pediatric urology practice
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DOI：
10.1016/j.juro.2007.10.086
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发表时间：
2008-03-01
影响因子：
6.6
通讯作者：
Thomas, John C.
中科院分区：
文献类型：
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作者：
Koski, Michelle E.;DeMarco, Romano T.;Thomas, John C.
目的：耐甲氧西林金黄色葡萄球菌是一种致病微生物，其流行率迅速上升。社区相关耐甲氧西林沙门氏菌。金黄色葡萄球菌在传染病界经常被讨论。然而，很少有人提到这个实体在泌尿学literature.Materials和方法：我们回顾了患者的记录与皮肤/软组织感染或记录耐甲氧西林S。结果：共纳入12例患者（33%为女性，67%为男性）。患者平均年龄为49个月（范围8 - 202）。在这些患者中，11例（92%）出现自发性感染，1例（8%）出现伤口感染。脓肿位置：腹股沟4例（33%），阴囊3例（25%），会阴2例（17%），肾周2例（17%），唇1例（8%）。转诊时最常见的体征是波动（30%）。虽然所有患者最终都需要手术引流，但初级保健医生的初始治疗包括观察7例患者（58%）的口服抗生素。共10株（83%）耐甲氧西林沙门氏菌。金黄色葡萄球菌和2个培养物（17%）为阴性。平均住院时间为5天（范围0 - 16天）。术后，大多数患者（58%）出院回家口服甲氧苄啶-磺胺甲恶唑。平均随访4个月（范围0 - 15）。术后1 ~ 15个月复发3例，平均6.3个月。金黄色葡萄球菌在社区中增加，并且可能在儿科和成人泌尿科实践中更常见。细菌菌株之间的区域差异使这些病例难以标准化。然而，提高对这种有毒微生物的认识是提供迅速和成功治疗的必要条件。
Purpose: Methicillin resistant Staphylococcus aureus is a virulent organism that has seen a rapid increase in prevalence. Community associated methicillin resistant S. aureus is discussed frequently in the infectious disease community. However, there has been little mention of this entity in the urological literature.Materials and Methods: We reviewed the records of patients presenting with skin/soft tissue infections or documented methicillin resistant S. aureus infection treated at an academic pediatric urology practice between October 2004 and August 2006.Results: A total of 12 patients were included (33% female, 67% male). Mean patient age was 49 months (range 8 to 202). Of the patients 11 (92%) presented with spontaneous infection and 1 (8%) presented with a wound infection. Abscess location was inguinal in 4 patients (33%), scrotal in 3 (25%), perineal in 2 (17%), perinephric in 2 (17%) and labial in 1 (8%). The most common presenting sign at referral was fluctuance (30%). While all patients eventually required surgical drainage, initial treatment by the primary care physician consisted of observation on oral antibiotics in 7 patients (58%). A total of 10 cultures (83%) revealed methicillin resistant S. aureus and 2 cultures (17%) were negative. Mean hospital stay was 5 days (range 0 to 16). Postoperatively, most patients (58%) were discharged home on oral trimethoprim-sulfamethoxazole. Mean followup was 4 months (range 0 to 15). Recurrence was seen in 3 patients at I to 15 months postoperatively (mean 6.3).Conclusions: Methicillin resistant S. aureus is increasing in the community and will likely be seen more often in pediatric and adult urological practices. The regional differences among bacterial strains make a standardized approach to these cases difficult. However, increased awareness of this virulent organism is necessary to deliver prompt and successful treatment.