社區型MRSA皮膚感染：一病例報告

Community-associated MRSA Skin Infection a Case Report and Literature Review

楊慶輝(Ching-Huei Yang)

《內科學誌》 16卷4期 (2005/08) Pp. 190-194

https://doi.org/10.6314/JIMT.2005.16(4).06

摘要

金黃色葡萄球菌(Staphylococcus aureus; S. aureus)一直以來都是引起皮膚及軟組織感染的常見致病菌之一。以往認為社區型(community-associated)金黃色葡萄球菌所產生的感染是屬於抗藥性較低的菌種，也就是所謂的methicillin有效金黃色葡萄球菌(methicillin-susceptible Staphylococcus auerus; MSSA)。然而，不僅根據國外的報告也好，國內的情況也是一樣的，methicillin抗藥性金黃色葡萄球菌(methicillin-resistant Staphylococcus auerus; MRSA)在社區的感染中占著愈來愈重要的角色。這衝擊著我們臨床上治療病人時抗生素的選擇。本文報告一名11歲女孩，右下肢出現蜂窩性組織炎及皮下膿瘍，持續高燒不退。住院後使用第一代頭孢子菌抗生素治療，另外會診外科進行皮下膿瘍切開，引流及擴瘡術治療。病人的病情迅速獲得改善，但是隨後膿液細菌培養卻顯示出MRSA。社區型MRSA所引起的皮膚及軟組織感染，若為單純性皮下膿瘍，治療上與以往並無不同，應以切閉，引流為主，輔以抗生素治療。但是，當我們治療的對象是嚴重而危及生命的感染時（例如敗血性休克），第一線用藥應不再是以往所認為的乙內醯膠類(β-lactam)抗生素，而必需考應使用醣胜肽類(glycopeptide)或其它對MRSA有效的抗生素。

關鍵字

金黃色葡萄球菌 ； 社區型 ； methicillin抗藥性金黃色葡萄球菌 ； 醣胜肽類

並列摘要

Staphylococcus aureus (S. aureus) is the common causative agent in skin and soft tissue infections (SSTIs). Usually, most cases were caused by methicillin-susceptible strains, but there are a trend in increasing methicillin-resistant S. aureus strains among the world. The reason for the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) as a potentially invasive pathogen is still unknown, and this phenomenon can not be simply explained by the spreading of nosocomial strains into the community. A case of cellulitis with subcutaneous abscess caused by MRSA in community is reported. Treatment for subcutaneous abscess caused by community-associated MRSA is the same as by MSSA. Adequately surgical drainage and debridement is the most important step, in addition to antibiotic therapy. And β-lactam antibiotics are no longer the first choices of empirical antimicrobial therapy for the patients with complicated community-acquired SSTIs. Glycopeptides or other effective antibiotics to MRSA should be selected early for life-threatening situations and/or when resistant strains are suspected.

並列關鍵字

Staphylococcus aureus ； S. aureus ； Community-associated ； Methicillin-resistant Staphylococcus aureus ； MRSA ； Glycopeptide