摘要
目的提高对耐甲氧西林金黄色葡萄球菌(Methicillinresistantstaphylococcusaureus,MRSA)感染的认识及诊治水平。方法回顾总结2000年～2004年5年间我科收治的6例鼻鼻窦耐甲氧西林金黄色葡萄球菌感染病人的临床表现、实验室检查、治疗措施及结果。结果①6例病人均有鼻鼻窦手术史,手术后2～4周出现症状。②鼻鼻窦耐甲氧西林金黄色葡萄球菌感染的临床症状有发热、头痛、鼻溢增多等,鼻内镜检查可见鼻窦黏膜肿胀、鼻腔鼻窦脓性分泌物及痂皮,分泌物恶臭。③分泌物(1例入院前、5例入院后)细菌培养证实均为耐甲氧西林金黄色葡萄球菌感染,药敏试验发现所有耐甲氧西林金黄色葡萄球菌对万古霉素敏感,其中2例对呋喃妥因敏感、对氧氟沙星中度敏感,另1例对利福平敏感,所有病人血培养均为阴性。④6例病人均予以静滴万古霉素治疗,辅以鼻内镜下鼻腔鼻窦换药并碘伏冲洗,临床症状消失、鼻内镜检查分泌物明显减少、细菌培养5例阴性、1例无致病菌生长,停药出院。结论广谱抗生素的使用、鼻鼻窦术后术腔开放增加感染途径均易增加耐甲氧西林金黄色葡萄球菌的出现。对于鼻鼻窦术后出现典型临床症状的病人应及时行细菌学检查,并依据药敏结果予以恰当的全身及局部治疗,同时需做好消毒隔离措施,防止交叉传染。
Objective To improve the diagnosis and treatment of methicillin-resistant staphylococcus aureus （MRSA） infection. Methods Six patients suffering from MRSA infection treated in our department in the past 5 years were reviewed retrospectively. Results ① All six patients had the history of rhinosinal surgery. ② Their main clinical manifestations were fever, headache, increased rhinorrhea within 2 to 4 weeks postoperatively. Rhinosinal endoscopic examination showed mucosal swelling of sinus, increased purulent rhinorrhea and scab with stench. ③ Secretion culture approved the existence of MRSA infection in all of the cases and all sensitive to vancomycin. Of them, 2 were sensitive to nitrofurantoin, moderately sensitive to ciprofloxacin and 1 sensitive to rifampicin. ④ All six patients had received intravenous injection of vancomycin for 6 to 8 days accompanied by rhinosinal rinse with iodophor. They left hospital when their symptoms disappeared, rhinorrhea markedly decreased with negative culturation. Conclusion The use of broad-spectrum antibiotics and open of antrum after rhinosinal surgery redound to the emergence of MRSA. For those patients with typical clinical manifestations after rhinosinal surgery, nasal discharge culture should be done betimes to confirm or exclude infection of MRSA. Once MRSA infection approved, proper systemic and local treatment should be applied according to the culture results. To prevent the across - contamination, strict antisepsis and isolation measures should be taken.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2005年第4期266-269,共4页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
