背景:尽管新生儿金黄色葡萄球菌肺炎很常见,通常可以治愈,它也可能是难治性和危及生命的。在这里,我们报告了一例严重的新生儿社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)坏死性肺炎伴双侧复发性化脓性气胸,呼吸衰竭,心力衰竭,还有心脏骤停.我们希望我们的报告将增加对这种疾病的理解。
方法:一个18岁的男孩咳嗽了五天,发烧三天,和呼吸困难两天。入院前胸片显示双肺有高密度阴影。一入场,在同步间歇强制通气下,他的氧饱和度波动约90%。他昏迷了,呼吸困难,微弱的心音和肝肿大。他的左肺各处都有湿润的裂纹,而右肺的呼吸音减少。高频振荡通气后,经验性抗菌药物(美罗培南和万古霉素),改善流通,右胸膜腔引流治疗右气胸(约90%压迫),他的氧饱和度保持在95%以上,观察到右肺的募集。直到住院第5天(DOH5),他的病情才恶化。在DOH5的早晨,他的氧饱和度下降。随后的胸部X光片显示双侧气胸,左肺受压近100%。左胸膜腔紧急引流术后饱和度未缓解,此后不久发生了心脏骤停。尽管通过紧急复苏和抢救抗菌治疗(利奈唑胺和左氧氟沙星)恢复了他的自发心跳,但考虑到MRSA的检测和抗菌敏感性,他没有表现出任何改善,伴有复发性脓性气胸,持续引流脓性液体和胸膜腔坏死的肺组织碎片。最终,他的父母拒绝了体外膜氧合(ECMO)并放弃了所有的治疗,新生儿在DOH13戒断后不久就去世了。
结论:新生儿MRSA肺炎可以是难治性和致死性的,尤其是在坏死性肺炎导致广泛的肺坏死和复发性气胸的情况下。尽管使用了利奈唑胺和其他医疗措施进行了治疗,它可能仍然无效。目前,ECMO是一种治疗方法,但是如果肺组织被严重侵蚀而无法修复,除非可以控制感染并进行肺移植,否则它可能是无用的。无论是否启动ECMO,成功治疗的关键是尽快控制MRSA引起的肺炎,并尽可能逆转肺损伤。
BACKGROUND: Although neonatal Staphylococcus aureus pneumonia is common and usually curable, it can also be refractory and life-threatening. Herein, we report a case of severe neonatal community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) necrotizing pneumonia with bilateral recurrent
pyopneumothorax, respiratory failure, heart failure, and cardiac arrest. We hope our report will add to the understanding of this disease.
METHODS: An 18-d-old boy presented with cough for five days, fever for three days, and dyspnea for two days. Preadmission chest radiograph revealed high-density shadows in both lungs. On admission, his oxygen saturation fluctuated around 90% under synchronized intermittent mandatory ventilation. He was unconscious, with dyspnea, weak heart sounds and hepatomegaly. Moist crackles were present throughout his left lung, while the breath sounds in the right lung were decreased. After high-frequency oscillatory ventilation, empiric antimicrobials (meropenem and vancomycin), improved circulation, and right pleural cavity drainage for right pneumothorax (approximately 90% compression), his oxygen saturation level stayed above 95%, and recruitment of the right lung was observed. His condition did not deteriorate until the 5th day of hospitalization (DOH 5). On the morning of DOH 5, his oxygen saturation decreased. Subsequent chest radiograph showed bilateral pneumothorax with nearly 100% compression of the left lung. Desaturation was not relieved after urgent left pleural cavity drainage, and cardiac arrest occurred soon thereafter. Although his spontaneous heartbeat returned through emergency resuscitation and salvage antibacterial therapy (linezolid and levofloxacin) was administered given the detection and antimicrobial susceptibility of MRSA, he showed no improvement, with recurrent
pyopneumothorax and continued drainage of purulent fluid and necrotic lung tissue fragments from the pleural cavity. Eventually, his parents refused extracorporeal membrane oxygenation (ECMO) and gave up all the treatments, and the newborn passed away soon after withdrawal on DOH 13.
CONCLUSIONS: Neonatal MRSA pneumonia can be refractory and lethal, especially in cases where necrotizing pneumonia leads to extensive lung necrosis and recurrent pneumothorax. Despite treatment with linezolid and other medical measures, it may still be ineffective. Currently, ECMO has been a remedial therapy, but if the lung tissue is too severely eroded to be repaired, it may be useless unless the infection can be controlled and lung transplantation can be performed. Regardless of whether ECMO is initiated, the key to successful treatment is to achieve control over the pneumonia caused by MRSA as soon as possible and to reverse lung injury as much as possible.