PDF(Pubmed)
Abstract：
BACKGROUND: Preterms are at risk of systemic infections as the barrier function of their immature skin is insufficient. The long period of hospitalization and the huge number of invasive procedures represent a risk factor for complications. Among the nosocomial infections of the skin, methicillin-resistant Staphylococcus aureus (MRSA) is associated with significant morbidity and mortality. We report a clinical case of cellulitis and abscess in two preterm twins caused by MRSA in a tertiary level Neonatal Intensive Care Unit (NICU).
METHODS: Two preterm female babies developed cellulitis from MRSA within the first month of extrauterine life. The first one (BW 990 g) showed signs of clinical instability 4 days before the detection of a hyperaemic and painful mass on the thorax. The second one (BW 1240 g) showed signs of clinical instability contextually to the detection of an erythematous, oedematous and painful area in the right submandibular space. In both cases the diagnosis of cellulitis was confirmed by ultrasound. A broad spectrum, multidrug antimicrobial therapy was administered till complete resolution.
CONCLUSIONS: Due to the characteristic antibiotic resistance of MRSA and the potential complications of those infections in such delicate patients, basic prevention measures still represent the key to avoid the spreading of neonatal MRSA infections in NICUs, which include hand hygiene and strict precautions, as well as screening of patients for MRSA on admission and during hospital stay, routine prophylactic topical antibiotic of patients, enhanced environmental cleaning, cohorting and isolation of positive patients, barrier precautions, avoidance of ward crowding, and, in some units, surveillance, education and decolonization of healthcare workers and visiting parents.
METHODS: Two preterm female babies developed cellulitis from MRSA within the first month of extrauterine life. The first one (BW 990 g) showed signs of clinical instability 4 days before the detection of a hyperaemic and painful mass on the thorax. The second one (BW 1240 g) showed signs of clinical instability contextually to the detection of an erythematous, oedematous and painful area in the right submandibular space. In both cases the diagnosis of cellulitis was confirmed by ultrasound. A broad spectrum, multidrug antimicrobial therapy was administered till complete resolution.
CONCLUSIONS: Due to the characteristic antibiotic resistance of MRSA and the potential complications of those infections in such delicate patients, basic prevention measures still represent the key to avoid the spreading of neonatal MRSA infections in NICUs, which include hand hygiene and strict precautions, as well as screening of patients for MRSA on admission and during hospital stay, routine prophylactic topical antibiotic of patients, enhanced environmental cleaning, cohorting and isolation of positive patients, barrier precautions, avoidance of ward crowding, and, in some units, surveillance, education and decolonization of healthcare workers and visiting parents.
摘要：
背景：早产有全身性感染的风险，因为未成熟皮肤的屏障功能不足。长期住院和大量侵入性手术是并发症的危险因素。在皮肤的医院感染中，耐甲氧西林金黄色葡萄球菌(MRSA)与显著的发病率和死亡率相关。我们报告了在三级新生儿重症监护病房（NICU）中由MRSA引起的两名早产双胞胎中蜂窝织炎和脓肿的临床病例。
方法：两名早产女婴在宫外孕的第一个月内发生MRSA蜂窝织炎。第一个（BW990g）在检测到胸部高血和疼痛性肿块前4天显示出临床不稳定的迹象。第二个（BW1240g）在检测到红斑的背景下显示出临床不稳定的迹象，右颌下间隙的水肿和疼痛区域。在这两种情况下，都通过超声确认了蜂窝织炎的诊断。广谱，进行多药抗菌治疗直至完全缓解.
结论：由于MRSA的特征性抗生素耐药性和这些感染在这些脆弱患者中的潜在并发症，基本的预防措施仍然是避免新生儿MRSA感染在NICU传播的关键,其中包括手部卫生和严格的预防措施，以及在入院时和住院期间对患者进行MRSA筛查，患者的常规预防性局部抗生素，加强环境清洁，阳性患者的队列和隔离，屏障预防措施,避免病房拥挤，and,在一些单位,监视,医护人员和来访父母的教育和非殖民化。
方法：两名早产女婴在宫外孕的第一个月内发生MRSA蜂窝织炎。第一个（BW990g）在检测到胸部高血和疼痛性肿块前4天显示出临床不稳定的迹象。第二个（BW1240g）在检测到红斑的背景下显示出临床不稳定的迹象，右颌下间隙的水肿和疼痛区域。在这两种情况下，都通过超声确认了蜂窝织炎的诊断。广谱，进行多药抗菌治疗直至完全缓解.
结论：由于MRSA的特征性抗生素耐药性和这些感染在这些脆弱患者中的潜在并发症，基本的预防措施仍然是避免新生儿MRSA感染在NICU传播的关键,其中包括手部卫生和严格的预防措施，以及在入院时和住院期间对患者进行MRSA筛查，患者的常规预防性局部抗生素，加强环境清洁，阳性患者的队列和隔离，屏障预防措施,避免病房拥挤，and,在一些单位,监视,医护人员和来访父母的教育和非殖民化。
