Methicillin Resistant Staphylococcus Aureus Purulent Pericarditis: A Case Report

耐甲氧西林金黃色葡萄球菌化膿性心包炎：病例報告

許祐銓(Yu-Chiuan Hsu) ； 許人文(Jen-Wen Hsu) ； 鄭鴻璋(Horng-Chang Cheng) ； 許維邦(Wei-Pang Hsu)

《台灣家庭醫學雜誌》 26卷2期 (2016/06) Pp. 109-115

https://doi.org/10.3966/168232812016062602005

摘要

金黃色葡萄球菌是一種常見繁殖在於粘膜和皮膚的細菌，會造成有廣泛的臨床表現。金黃色葡萄球菌感染在過去20年中逐漸增加，並且伴隨許多抗生素抗藥性菌株，特別是耐甲氧西林金黃色葡萄球菌(MRSA)菌株。具耐β-lactamase的抗藥性。軟組織感染、肺炎、敗血症、骨髓炎或心內膜炎皆是MRSA感染的常見表現。MRSA相關的心包炎是一種非常罕見的疾病。詳細詢問病史，包括過去的醫療病史和使用藥物的記錄，並進行徹底的身體檢查，是對一位免疫功能缺損伴有心臟衰竭或是敗血症跡象患者的早期診斷關鍵。積極治療可以幫助防止潛在的致命性結果。

關鍵字

耐甲氧西林金黃色葡萄球菌 ； 化膿性心包炎 ； 心包穿刺 ； 免疫功能缺損

並列摘要

Staphylococcus aureus (S. aureus) is a frequent colonizer of the mucosa and skin. A broad range of clinical presentations can be caused by this microorganism. S. aureus infections have increased in the past 20 years, and this has been accompanied by a rise in antibiotic-resistant strains, in particular, Methicillin-Resistant Staphylococcus Aureus (MRSA) strains. MRSA is a specific strain of S. aureus that has developed antibiotic resistance to ß-lactams. Soft-tissue infections, pneumonia, septicemia, osteomyelitis or endocarditis are frequent manifestations of MRSA infections. MRSAassociated purulent pericarditis is a very rare occurrence. Obtaining a detailed history, including past medical and drug histories, and performing a thorough physical examination, are the keys to early diagnosis of this deadly condition in patients who are immunocompromised and accompanied by conditions of heart failure and/or sepsis. Aggressive treatment can help prevent a potentially fatal outcome.

並列關鍵字

immunocompromised ； MRSA ； pericardiocentesis ； purulent pericarditis

參考文獻

Shivaraju, A,Luu, J,Bratis, C(2008).Community-acquired MRSA pericarditis.Cardiol Rev.25,39-43.

Khan, MA,Pitcher, DV,Wyncolt, SJ(2006).Methicillin resistant Staphylococcus aureus (MRSA) pericarditis.Pakistan J Pathol.17,170-2.

Tsang, TS,Enriquez-Sarano, M,Freeman, WK(2002).Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns and outcomes spanning 21 years.Mayo Clin Proc.77,429.

Parikh, SV,Memon, N,Echols, M(2009).Purulent pericarditis: report of 2 cases and review of the literature.Medicine.88,52-65.

Imazio, M,Adler, Y(2013).Management of pericardial effusion.Eur Heart J.34,1186.