临床儿科杂志 ›› 2024, Vol. 42 ›› Issue (8): 728-736.doi: 10.12372/jcp.2024.23e1225

• 儿科大查房 • 上一篇    下一篇

复杂性先天性心脏病术后耐甲氧西林金黄色葡萄球菌所致儿童感染性心内膜炎的救治与思考

黄诗喻1, 王薇1, 朱荻绮2, 沈捷2, 曹清1()   

  1. 1.上海交通大学医学院附属上海儿童医学中心 感染科(上海 200127)
    2.上海交通大学医学院附属上海儿童医学中心 心内科(上海 200127)
  • 收稿日期:2023-12-26 出版日期:2024-08-15 发布日期:2024-08-06
  • 通讯作者: 曹清 电子信箱:caoqing@scmc.com.cn

Treatment and reflection of infective endocarditis caused by methicillin-resistant Staphylococcus aureus in children after complex congenital heart disease

HUANG Shiyu1, WANG Wei1, ZHU Diqi2, SHEN Jie2, CAO Qing1()   

  1. 1. Department of Infectious Disease, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
    2. Department of Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
  • Received:2023-12-26 Online:2024-08-15 Published:2024-08-06

摘要:

患儿,男,6岁10月龄,因“反复发热2个月,精神不佳半天”就诊于我院。患儿既往有先天性心脏病,改良体-肺循环分流术后出现发热,多次血培养提示耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)阳性,超声心动图示管道不通畅,诊断为感染性心内膜炎,予万古霉素、利奈唑胺、美罗培南等抗感染,患儿用药后骨髓抑制明显,感染控制不佳,行急诊手术摘除赘生物、中央分流术后仍反复发热,改用康替唑胺抗感染治疗后患儿病情改善,感染稳定控制,随访半年患儿无反复感染,未见脏器损伤及骨髓抑制现象,超声心动图示血流通畅。本病例拟为临床医师应对此类复杂感染提供临床思路,并对儿童耐药菌抗感染治疗药物选择进行探讨。

关键词: 感染性心内膜炎, 耐甲氧西林金黄色葡萄球菌, 抗生素, 康替唑胺, 儿童

Abstract:

The patient, male, 6 years and 10 months old, was admitted to our hospital because of “repeated fever for 2 months and mental fatigue for half a day”. The patient had congenital heart disease in the past, and fever occurred after modified body to pulmonary circulation shunt. Multiple blood cultures indicated methicillin-resistant Staphylococcus aureus (MRSA), and echocardiography indicated that the tube was not smooth. The patient was diagnosed with infective endocarditis, and vancomycin, linezolid, meropenem and other anti-infective drugs were given. After the use of drugs, bone marrow suppression is obvious, infection control is poor. Emergency surgery was performed to remove the redundant organisms and recurrent fever after central shunt surgery. The patient’s condition improved and the infection was stably controlled, after switched to contizolamide anti-infective treatment with contezolid. Follow-up six months, the child has no recurrent infections, there is no organ damage and bone marrow suppression phenomenon, the echocardiogram showed that the blood flow is smooth. This case is intended to provide clinical ideas for clinicians to deal with this kind of complex infection, and to discuss the choice of drugs for anti-infection treatment of drug-resistant bacteria in children.

Key words: infective endocarditis, methicillin-resistant Staphylococcus aureus, antibiotic, contezolid, child