- 期刊
Treatment of Severe Methicillin-Resistant Staphylococcus Aureus Infection in Intravenous Drug User Presented with Necrotizing Fasciitis and Infectious Endocarditis Simultaneously
嚴重抗藥性金黃色葡萄球菌感染同時造成壞死性筋膜炎以及感染性心內膜炎之治療
摘要
背景：壞死性筋膜炎及感染性心內膜炎都是致命的感染，而藥物濫用者較為容易罹患這些感染症。目的及目標：對於藥物濫用者，及早診斷潛藏感染是困難的。對於壞死性筋膜炎，需要儘早手術及適當抗生素治療。針對感染性心內膜炎，須在取得血液培養後立即投與抗生素，若進展至心臟衰竭或持續性的感染時，則必須進行手術治療。材料及方法：一名34歲海洛因藥物濫用女性在住院兩周前開始於左大腿產生疼痛及紅腫，臨床醫師判斷為壞死性筋膜炎且進行緊急筋膜清創手術。但清創手術中的發現並不如同臨床表徵地嚴重，於是進一步全身感染源檢驗卻發現同時患有感染性心內膜炎。結果：早期的診斷、良好的心臟手術治療及正確的抗生素使用下，病患順利存活;於三個月後的門診追蹤並無任何併發症或者功能損失。結論：我們提出一名患者為海洛因藥物濫用者感染抗藥性金黃色葡萄球菌並經由血流傳播同時造成壞死性筋膜炎及感染性心內膜炎。早期的診斷、良好的心臟手術治療及正確的抗生素使用下，病患順利存活。細心詢問過去病史及鑑別診斷才能避免錯誤診斷及達到良好治療效果。
關鍵字
無資料並列摘要
Background: Necrotizing fasciitis and infections endocarditis both are highly lethal infections. Intravenous drug user (IVDU) is often vulnerable to such uncommon infections. Aim and Objectives: Early detection of occult infections in IVDU is difficult. The main treatment for necrotizing fasciitis is early surgical intervention and appropriate antimicrobial therapy. For infectious endocarditis, antibiotic treatment should be start immediately after blood cultures are obtained, and surgical intervention should be performed if the patient has refractory heart failure, persistent or recurrent infections. Materials and Methods: A 34-year-old female who had history of Heroin abuse for years, suffered from a two-week history of progressive painful swelling of left thigh. Clinical assessment indicated necrotizing fasciitis and emergent fasciectomy was done. But the surgical finding was not compatible with clinical appearance. Further diagnostic study was done and Methicillin-resistant Staphylococcus aureus (MRSA) infectious endocarditis was noted. Results: With early definite diagnosis, appropriate cardiac surgery and prompt antibiotic treatment, the patient survived well. There is no complication or functional deficit noted in our clinic follow-up three months later. Conclusion: Herein we present a case of IVDU who had MRSA infection with blood stream spreading causing necrotizing fasciitis and infective endocarditis simultaneously. With early definite diagnosis, appropriate surgery and prompt antibiotic treatment, we treated the patient well. Therefore, carefully tracing the past history and making meticulous differential diagnosis are necessary to prevent misdiagnosis and ensure best therapeutic outcome.
延伸閱讀
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