儿童先天性耳前瘘管感染葡萄球菌48例临床分析

Clinical analysis of staphylococcus infection of congenital preauricular fistula in 48 children

摘要:

目的探讨儿童先天性耳前瘘管感染葡萄球菌后采用抗生素及手术治疗的临床疗效。方法回顾性分析2016年6月—2024年6月收治的48例先天性耳前瘘管感染葡萄球菌患者的临床资料，其中男16例，女32例；年龄4个月至18岁，平均年龄(5.29±3.73)岁。依据葡萄球菌种类将患者分为金黄色葡萄球菌组(19例)和凝固酶阴性葡萄球菌组(29例)，比较两组患者术后切口乙级愈合情况及使用抗生素的差异，寻找更合理的抗生素选择及手术效果。结果 19例金黄色葡萄球菌组患者术后切口乙级愈合5例，29例凝固酶阴性葡萄球菌组患者术后切口乙级愈合0例，差异具有统计学意义(P＜0.05)。金黄色葡萄球菌组使用特殊级抗生素4例，凝固酶阴性葡萄球菌组使用特殊级抗生素0例，差异具有统计学意义(P＜0.05)。葡萄球菌对利奈唑胺、万古霉素、复方磺胺甲噁唑的敏感率100%，对苯唑西林的敏感率53.33%。41例(85.42%)先天性耳前瘘管合并葡萄球菌感染患者经过使用非特殊级抗生素+耳前瘘管切除术+清创术治疗后切口能够达到甲级愈合。2例(4.17%)患者使用抗生素后出现了皮疹等不良反应。出现不良反应的抗生素均为复方磺胺甲噁唑。结论儿童先天性耳前瘘管感染葡萄球菌时，凝固酶阴性葡萄球菌是主要致病菌，金黄色葡萄球菌是次要致病菌。相较于凝固酶阴性葡萄球菌，金黄色葡萄球菌感染时的特殊级抗生素的使用率及术后切口乙级愈合率更高。葡萄球菌感染时，初期的治疗方案推荐使用非特殊级抗生素＋耳前瘘管切除术＋清创术的治疗方案，术后出现感染时则依据药敏结果调整抗生素。

Abstract:

Objective To explore the clinical effect of antibiotic and surgical treatment for staphylococcus infection of congenital preauricular fistula in children. Methods Clinical data of 48 patients with congenital preauricular fistula infection caused by staphylococcus admitted to our department from June 2016 to June 2024 were retrospectively analyzed. Of them, 16 were male and 32 were female, ranging in age from 4 months to 18 years with an average of (5.29±3.73) years. According to staphylococcus species, the patients were divided into Staphylococcus aureus group (19 cases) and coagulase-negative staphylococcus group (29 cases). The differences of grade B incision healing and antibiotic use between the two groups were compared, so as to find more reasonable antibiotic selection and surgical outcomes. Results Grade B incision healing occurred in 5 of 19 patients of the staphylococcus aureus group and 0 of 29 patients of the coagulase-negative staphylococcus group, the difference was statistically significant (P<0.05). Four cases in the staphylococcus aureus group and none in the coagulase-negative staphylococcus group received special antibiotics treatment, the difference was statistically significant (P<0.05). The sensitive rates of staphylococcus to linezolid, vancomycin and compound sulfamethoxazole were 100%, and that to oxacillin was 53.33%. Forty-one (85.42%) of all the patients achieved grade A healing after treatment with non-specific antibiotics and preauricular fistula resection. Two patients (4.17%) experienced adverse reactions such as rash after using antibiotics, and the antibiotics with adverse reactions in both cases was compound sulfamethoxazole. Conclusions Coagulase-negative staphylococcus is the main pathogenic bacterium in congenital preauricular fistula infection with staphylococcus in children. In patients with congenital preauricular fistula infected by staphylococcus aureus, there is a higher rate of use of special antibiotics and a higher rate of grade B incision healing. When infected with methicillin-resistant staphylococcus aureus, medication should be guided by drug sensitivity results, and it is recommended to use linezolid, vancomycin, or compound sulfamethoxazole, but caution should be taken against adverse reactions of compound sulfamethoxazole. And specific antibiotics and preauricular fistula resection as well as debridement are recommended for those patients.