PDF(Pubmed)
Abstract：
BACKGROUND: The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has increased the incidence of community-onset MRSA infection. Respiratory tract infections caused by MRSA has been noted for their severity; however, repeated relapses that require extended antibiotic therapy are rare.
METHODS: We report a case of relapsing bronchopneumonia caused by CA-MRSA in a 56-year-old man. The patient responded to antibiotics, but repeatedly relapsed after stopping treatment. MRSA was consistently isolated from airway specimens during each relapse. Extended oral antibiotic treatment with trimethoprim/sulfamethoxazole (TMP/SMX) for 6 months achieved infection control. Whole-genome sequencing of the isolated strain revealed that the causative agent was sequence type (ST)1/staphylococcal cassette chromosome mec (SCCmec) type IVa, a clone that is rapidly increasing in Japan.
CONCLUSIONS: This patient had an unusual course of MRSA bronchopneumonia with repeated relapses. Although the choice of antibiotics for long-term use in MRSA respiratory tract infections has not been well established, TMP/SMX was effective and well tolerated for long-term therapy in this case. The clinical course of infections related to the rapid emerging clone, ST1/SCCmec type IVa warrants further attention.
METHODS: We report a case of relapsing bronchopneumonia caused by CA-MRSA in a 56-year-old man. The patient responded to antibiotics, but repeatedly relapsed after stopping treatment. MRSA was consistently isolated from airway specimens during each relapse. Extended oral antibiotic treatment with trimethoprim/sulfamethoxazole (TMP/SMX) for 6 months achieved infection control. Whole-genome sequencing of the isolated strain revealed that the causative agent was sequence type (ST)1/staphylococcal cassette chromosome mec (SCCmec) type IVa, a clone that is rapidly increasing in Japan.
CONCLUSIONS: This patient had an unusual course of MRSA bronchopneumonia with repeated relapses. Although the choice of antibiotics for long-term use in MRSA respiratory tract infections has not been well established, TMP/SMX was effective and well tolerated for long-term therapy in this case. The clinical course of infections related to the rapid emerging clone, ST1/SCCmec type IVa warrants further attention.
摘要：
背景：社区相关性耐甲氧西林金黄色葡萄球菌（CA-MRSA）的出现增加了社区型MRSA感染的发生率。已经注意到由MRSA引起的呼吸道感染的严重程度；然而，需要延长抗生素治疗的反复复发很少见.
方法：我们报告一例56岁男性CA-MRSA引起的复发性支气管肺炎。病人对抗生素有反应，但在停止治疗后反复复发。在每次复发期间，从气道标本中始终分离出MRSA。甲氧苄啶/磺胺甲恶唑（TMP/SMX）延长口服抗生素治疗6个月，可控制感染。分离菌株的全基因组测序显示病原体为序列型（ST）1/葡萄球菌盒染色体mec（SCCmec）IVa型，在日本迅速增加的克隆。
结论：该患者的MRSA支气管肺炎病程异常，反复复发。尽管在MRSA呼吸道感染中长期使用抗生素的选择尚未得到很好的确定，在这种情况下，TMP/SMX对长期治疗有效且耐受性良好。与快速出现的克隆相关的感染的临床过程，ST1/SCCmec型IVa值得进一步关注。
方法：我们报告一例56岁男性CA-MRSA引起的复发性支气管肺炎。病人对抗生素有反应，但在停止治疗后反复复发。在每次复发期间，从气道标本中始终分离出MRSA。甲氧苄啶/磺胺甲恶唑（TMP/SMX）延长口服抗生素治疗6个月，可控制感染。分离菌株的全基因组测序显示病原体为序列型（ST）1/葡萄球菌盒染色体mec（SCCmec）IVa型，在日本迅速增加的克隆。
结论：该患者的MRSA支气管肺炎病程异常，反复复发。尽管在MRSA呼吸道感染中长期使用抗生素的选择尚未得到很好的确定，在这种情况下，TMP/SMX对长期治疗有效且耐受性良好。与快速出现的克隆相关的感染的临床过程，ST1/SCCmec型IVa值得进一步关注。
