凝結酶陰性葡萄球菌敗血症

Coagulase-Negative Staphylococcal Septicemia

黃富源(Fu-Yuan Huang) ； 王清虹(Ching-Hung Wang) ； 邱南昌(Nan-Chang Chiu)

《Acta Paediatrica Sinica》 35卷5期 (1994/10) Pp. 423-428

https://doi.org/10.7097/APS.199410.0423

摘要

凝結酶陰性葡萄球菌敗血症近年來在小兒科，尤以新生兒加護病房內，已成為院內感染敗血症中最常見的一種。馬階醫院小兒科收集自79年1月至81年6月間，确定為凝結酶陰性葡萄球菌的敗血症患者，共41例。其中小於三個月的嬰兒有35例，佔85%。早產兒有19例，其中14例體重小於1,500公克。患者接受的各種醫療處置中，靜脈內導管的置放佔100%，靜脈營養輸液之給予佔97.5%，為重要的感染危險因子。本院的病例中以Staphylococcus huminis引起之敗血症為最多。抗生素敏感度試驗，對methicillin具抗藥性者佔84.5%，而对methicilln有抗藥性者，對cephalosporin類有抗藥性產生這可能，在對methicillin無效之病例，不應用cephalosporin類，而應用vancomycin來治療。當懷疑有感染時，應侭快停止靜脈營養輸液，在作完兩次的血液培養後給予適當的抗生素。一般患者預後良好。

關鍵字

凝結酶陰性葡萄球菌 ； 血管內導管 ； 靜脈營養液

並列摘要

In the past decade, coagulase negative Staphylococcus(CNS) has become one of the most common pathogens in nosocomial septicemia, especially in neonatal intensive care units. From January 1, 1990 to June 30, 1992, we documented 41 cases of CNS septicemia in the Department of Pediatrics at Mackay Memorial Hospital. Thirty five cases (85%) were found in infants less than 3 months of age. Nineteen patients were premature babies. Of these, 14 had a body weight less than 1,500 gms. All of the patients had intravascular catheters and 40 patients (97.5%) were receiving total parenteral nutrition. The most common causative organism isolated in this study was Staphylococcus hominis. This differs from other reports where Staphylococcus epidermidis is the most common pathogen. Eighty five percent of the organisms were resistant to methicillin and 80% of these methicillin-resistant strains were also resistant to cephalosporins. All of the organisms were sensitive to vancomycin. Because of the possibility, of cross-resistance between methicillin and cephalosporin, vancomycin was chosen to treat the methicillin resistant cases. Total parenteral nutrition was discontinued before antibiotic treatment. When CNS septicemia was suspected clinically, we drew two blood cultures from different sites before beginning antibiotic therapy. This was an effort to get a definitive diagnosis. In general, the prognosis of CNS septicemia was good if early diagnosis can be made.

並列關鍵字

coagulase negative Staphylococcus (CNS) ； intravascular catheter ； total parenteral nutrition