Rhinosinusitis with MRSA Infection

鼻腔鼻竇炎合併抗二甲氧基苯青黴素金黃色葡萄球菌感染

江榮山(Rong-San Jiang) ； 張瀞玟(Jinq-Wen Jang) ； 許振益(Chen-Yi Hsu)

《中華民國耳鼻喉科醫學雜誌》 34卷2期 (1999/03) Pp. 93-98

https://doi.org/10.6286/1999.34.2.93

摘要

背景：抗二甲氧基苯青黴素金黃色葡萄球菌是一種具高度侵犯性細菌，要除去它頗為困難的。它已經成為一種常見院內感染細菌。可是，在院外感染它相對的較少被重視。另一方面，雖然金黃色葡萄球菌在頭頸部是一種常見的細菌，抗二甲氧基苯青黴素金黃色葡萄球菌的感染在鼻腔鼻竇部位卻很少被報告。
方法：我們從病歷表中尋找出在本科門診中被診斷為抗二甲氧基苯青黴素金黃色葡萄球菌鼻腔鼻竇炎的病患。在門診中，當鼻腔鼻竇炎病患對抗生素治療無效時，我們利用棉籤從中鼻道取標本做嗜氧菌及厭氧菌的培養來決定正確的抗生素。當抗二甲氧苯青黴素金黃色葡萄球菌被培養來後，包括抗生素及鼻腔沖洗的一些治療被嘗試用來治療這些病患。
結果：從民國84年7月到86年8月共有28名抗二甲氧基苯青黴素金黃色葡萄球菌鼻腔鼻竇炎病患在我們的門診中被診斷出。性別為16名男性，12名女性。年齡分佈從7歲到71歲。平均年齡是36.1歲。這些被抗二甲氧基苯青黴素金黃色葡萄球菌感染的病患中，6名是未曾接受鼻腔鼻竇手術的慢性鼻竇炎病患，3名是接受鼻甲部份切除手術的慢性肥厚性鼻炎病患。其餘的19名病患都曾接受內視鏡功能性鼻竇手術的適應症中，17名病患是慢性鼻竇炎，1例是非侵犯性霉菌鼻竇炎，1例是萎縮性鼻炎。臨床上，膿性鼻漏及鼻結痂是最常見的症狀。在這些被抗二甲氧基苯青黴素金黃色葡萄球菌感染的病患中，並沒有任何潛在的因素被發現。經過治療後，21名病患獲得改善
結論：抗二甲氧基苯青黴素金黃色葡萄球菌感染可能在鼻腔鼻竇炎病患的處理上帶來新的問題

關鍵字

抗二甲氧基苯青黴素金黃色葡萄球菌 ； 鼻腔鼻竇炎

並列摘要

Background: Methicillin-resistant Staphylococcus (MRSA) is a highly virulent bacterium which is difficult to eradicate. It has become a common nosocomail pathogen. However, it is relatively less emphasized in outpatient settings. Moreover, although Staphylococcus aureus is a common pathogen of the head and neck, MRSA infection in the sinonasal area rarely reported.
Methods: Charts were reviewed to find MRSA rhinosinusitis patients who were diagnosed in the Outpatient Clinic of the Department of Otolaryngology, Taichung Veterans General Hospital. When rhinosinusitis patients were not responsive to empiric antibiotic treatment in the Outpatient Clinic, specimens were taken from the middle meatus with cotton-tipped sticks. The specimens were sent for aerobic and anaerobic cultures to determine the appropriate antibiotics to be used for treatment. After MRSA was cultured, several treatments, including antibiotics and nasal irrigation, were used for these patients.
Results: Twenty-eight patients with MRSA rhinosinusitis were identified in our Outpatient Clinic between July 1995 and August 1997. Among them, 16 patients were male, and 12 were female. Their ages ranged from 7 to 71 years old. The mean age was 36.1 years. Six of these MRSA-infected patients were chronic sinusitis patients without any history of prior sinonasal surgery. Three were chronic hypertrophic rhinitis patients who had undergone a partial turbinectomy. The remaining 19 patients had undergone functional endoscopic sinus surgery (FESS). The indication for FESS chronic sinusitis in 17 patients, noninvasive fungal sinusitis in another, and atrophic rhinitis in the last. Mucopurulent nasal discharge and nasal crusting were the most common clinical manifestations. No responsible predisposing factor was found in these MRSA-infected patients. After treatment, 21 patients improved.
Conclusions: MRSA infection may constitute a new problem in the management of rhinosinusitis patients.

並列關鍵字

methicillin-resistant Staphylococcus aureus ； rhinosinusitis