Baidu
map

Clin Infect Dis:流感-MRSA肺炎的重症儿童:万古霉素单药治疗充分吗?

2019-02-27 王淳 环球医学

2019年1月,美国学者发表在《Clin Infect Dis》的一项研究表明,万古霉素单一治疗对于共感染耐甲氧西林金黄色葡萄球菌(MRSA)的流感相关重症儿童可能是不充分的。

2019年1月,美国学者发表在《Clin Infect Dis》的一项研究表明,万古霉素单一治疗对于共感染耐甲氧西林金黄色葡萄球菌(MRSA)的流感相关重症儿童可能是不充分的。

背景:儿童流感病毒和MRSA共感染可造成危及生命的坏死性肺炎。散发型发病率排除了抗生素有效性的评估。研究者评估了流感-MRSA肺炎的重症儿童的临床特征和结局,并评估了抗生素的使用。

方法:研究者纳入2008年11月~2016年5月34个儿童重症监护病房的流感感染合并呼吸衰竭的儿童(<18岁)。研究者比较了MRSA感染、非MRSA细菌感染和无细菌感染儿童的基线特征、临床结局和治疗方案。

结果:研究者纳入了170名儿童(127人甲型流感,43人乙型流感)。流感-MRSA肺炎儿童(30人,87%既往健康)比非MRSA(61人)或无(79人)细菌共感染的儿童岁数更大。与其他组相比,流感-MRSA与白细胞减少症、急性肺损伤、血管加压素的使用、体外生命支持和死亡率的增加相关(P≤0.0001)。共MRSA感染的儿童的流感相关死亡率为40%,无MRSA感染者为4.3%(相对风险[RR],9.3;95% 置信区间[CI],3.8~22.9)。29/30名住院后第一个24小时内接受万古霉素的MRSA儿童中,如果治疗方案也包括第二种抗MRSA抗生素,则死亡率为12.5%(2/16),而万古霉素单药治疗为69.2%(9/13)(RR,5.5;95% CI,1.4~21.3;P=0.003)。万古霉素剂量不影响初始谷水平,78%的儿童<10μg/mL。

结论:流感-MRSA共感染与重症儿童较高的致死性相关。这些数据支持可能重症病例早期添加第二种抗MRSA抗生素到万古霉素中可以获得更好临床收益。

原始出处:

Randolph AG, Xu R, Novak T, et al.Vancomycin Monotherapy May Be Insufficient to Treat Methicillin-resistant Staphylococcus aureus Coinfection in Children With Influenza-related Critical Illness.Clin Infect Dis. 2019 Jan 18;68(3):365-372. doi: 10.1093/cid/ciy495.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1687724, encodeId=bbca168e724c3, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Mon Apr 29 20:20:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2054867, encodeId=184a205486e8d, content=<a href='/topic/show?id=250012241d8' target=_blank style='color:#2F92EE;'>#mRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12241, encryptionId=250012241d8, topicName=mRS)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/7F67E3BE360D6DD1D0A62E3E71E23CB6/100, createdBy=9d8a2500148, createdName=ms8888626721583891, createdTime=Wed Nov 27 09:20:00 CST 2019, time=2019-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988111, encodeId=ecc6198811127, content=<a href='/topic/show?id=dab895920a2' target=_blank style='color:#2F92EE;'>#重症儿童#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95920, encryptionId=dab895920a2, topicName=重症儿童)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Sat May 25 00:20:00 CST 2019, time=2019-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012962, encodeId=8b67201296243, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Mon Jun 10 10:20:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393747, encodeId=2f4b1393e4757, content=<a href='/topic/show?id=ccc412243db' target=_blank style='color:#2F92EE;'>#MRSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12243, encryptionId=ccc412243db, topicName=MRSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Fri Mar 01 13:20:00 CST 2019, time=2019-03-01, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1687724, encodeId=bbca168e724c3, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Mon Apr 29 20:20:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2054867, encodeId=184a205486e8d, content=<a href='/topic/show?id=250012241d8' target=_blank style='color:#2F92EE;'>#mRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12241, encryptionId=250012241d8, topicName=mRS)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/7F67E3BE360D6DD1D0A62E3E71E23CB6/100, createdBy=9d8a2500148, createdName=ms8888626721583891, createdTime=Wed Nov 27 09:20:00 CST 2019, time=2019-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988111, encodeId=ecc6198811127, content=<a href='/topic/show?id=dab895920a2' target=_blank style='color:#2F92EE;'>#重症儿童#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95920, encryptionId=dab895920a2, topicName=重症儿童)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Sat May 25 00:20:00 CST 2019, time=2019-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012962, encodeId=8b67201296243, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Mon Jun 10 10:20:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393747, encodeId=2f4b1393e4757, content=<a href='/topic/show?id=ccc412243db' target=_blank style='color:#2F92EE;'>#MRSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12243, encryptionId=ccc412243db, topicName=MRSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Fri Mar 01 13:20:00 CST 2019, time=2019-03-01, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1687724, encodeId=bbca168e724c3, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Mon Apr 29 20:20:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2054867, encodeId=184a205486e8d, content=<a href='/topic/show?id=250012241d8' target=_blank style='color:#2F92EE;'>#mRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12241, encryptionId=250012241d8, topicName=mRS)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/7F67E3BE360D6DD1D0A62E3E71E23CB6/100, createdBy=9d8a2500148, createdName=ms8888626721583891, createdTime=Wed Nov 27 09:20:00 CST 2019, time=2019-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988111, encodeId=ecc6198811127, content=<a href='/topic/show?id=dab895920a2' target=_blank style='color:#2F92EE;'>#重症儿童#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95920, encryptionId=dab895920a2, topicName=重症儿童)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Sat May 25 00:20:00 CST 2019, time=2019-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012962, encodeId=8b67201296243, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Mon Jun 10 10:20:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393747, encodeId=2f4b1393e4757, content=<a href='/topic/show?id=ccc412243db' target=_blank style='color:#2F92EE;'>#MRSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12243, encryptionId=ccc412243db, topicName=MRSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Fri Mar 01 13:20:00 CST 2019, time=2019-03-01, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1687724, encodeId=bbca168e724c3, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Mon Apr 29 20:20:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2054867, encodeId=184a205486e8d, content=<a href='/topic/show?id=250012241d8' target=_blank style='color:#2F92EE;'>#mRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12241, encryptionId=250012241d8, topicName=mRS)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/7F67E3BE360D6DD1D0A62E3E71E23CB6/100, createdBy=9d8a2500148, createdName=ms8888626721583891, createdTime=Wed Nov 27 09:20:00 CST 2019, time=2019-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988111, encodeId=ecc6198811127, content=<a href='/topic/show?id=dab895920a2' target=_blank style='color:#2F92EE;'>#重症儿童#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95920, encryptionId=dab895920a2, topicName=重症儿童)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Sat May 25 00:20:00 CST 2019, time=2019-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012962, encodeId=8b67201296243, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Mon Jun 10 10:20:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393747, encodeId=2f4b1393e4757, content=<a href='/topic/show?id=ccc412243db' target=_blank style='color:#2F92EE;'>#MRSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12243, encryptionId=ccc412243db, topicName=MRSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Fri Mar 01 13:20:00 CST 2019, time=2019-03-01, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1687724, encodeId=bbca168e724c3, content=<a href='/topic/show?id=be223633375' target=_blank style='color:#2F92EE;'>#单药治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36333, encryptionId=be223633375, topicName=单药治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bef28414326, createdName=12498717m75(暂无昵称), createdTime=Mon Apr 29 20:20:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2054867, encodeId=184a205486e8d, content=<a href='/topic/show?id=250012241d8' target=_blank style='color:#2F92EE;'>#mRS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12241, encryptionId=250012241d8, topicName=mRS)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/1103841572/7F67E3BE360D6DD1D0A62E3E71E23CB6/100, createdBy=9d8a2500148, createdName=ms8888626721583891, createdTime=Wed Nov 27 09:20:00 CST 2019, time=2019-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1988111, encodeId=ecc6198811127, content=<a href='/topic/show?id=dab895920a2' target=_blank style='color:#2F92EE;'>#重症儿童#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95920, encryptionId=dab895920a2, topicName=重症儿童)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d521144, createdName=wrj0121, createdTime=Sat May 25 00:20:00 CST 2019, time=2019-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012962, encodeId=8b67201296243, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Mon Jun 10 10:20:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1393747, encodeId=2f4b1393e4757, content=<a href='/topic/show?id=ccc412243db' target=_blank style='color:#2F92EE;'>#MRSA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12243, encryptionId=ccc412243db, topicName=MRSA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ce072500140, createdName=12498b3em08(暂无昵称), createdTime=Fri Mar 01 13:20:00 CST 2019, time=2019-03-01, status=1, ipAttribution=)]

相关资讯

探案:这例大叶性肺炎,是经典病原体引起的吗?

患者女性,71岁。主诉:发热1周,咳嗽咳痰4天。

2018 台湾肺炎治疗指南

肺炎是全球范围内导致死亡的主要原因,台湾肺炎治疗指南建议的主要内容包括肺炎的流行病学以及成人社区获得性肺炎,医院获得性肺炎,呼吸机相关性肺炎,医疗相关肺炎和儿童肺炎的抗生素治疗建议。

NEJM:Omadacycline治疗社区获得性细菌性肺炎

研究认为Omadacycline治疗社区获得性细菌性肺炎的效果与莫西沙星相当

孩子明明是肺炎,为啥医生关心身高问题?

患儿,住院号414XX8,男,5岁。15天前无明显诱因出现咳嗽气喘,无发热;15天来反复就诊于多家医院。

北京和睦家医院专家提醒:儿童4种情形警惕早期肺炎

临近年末北京仍未下雪,空气干燥和气温起伏不定,让原本就高发的儿童呼吸道感染疾病在这个冬天显得更加严重。北京和睦家医院专家提醒,当孩子同时出现咳嗽、发热、精神不好等四种情形,家长需“留神”关注、识别是否为早期肺炎,应及时就医并预防重症肺炎发生。 北京和睦家医院儿科医生为患儿进行诊疗 空气干燥气温反复  催发儿童肺炎进入高发季临近年末北京仍未下雪,空气干燥和气温起伏不定,让原本就高发的儿童

Chest:培养阴性医源性肺炎 抗MRSA降阶梯治疗是否影响结局?

2019年1月,发表在《Chest》的一项研究调查了对于培养阴性医源性肺炎患者,抗耐甲氧西林金黄色葡萄球菌(MRSA)降阶梯(DE)是否影响28天医院死亡率、ICU时间和住院日。结果显示,28天死亡率没改变,但是医院LOS较短和急性肾损伤(AKI)发生率较低。

Baidu
map
Baidu
map
Baidu
map