Jung, Sehwa
(Division of Neonatology, Department of Pediatrics, Ajou University School of Medicine)
,
Jeong, Kyung Uk
(Division of Neonatology, Department of Pediatrics, Ajou University School of Medicine)
,
Lee, Jang Hoon
(Division of Neonatology, Department of Pediatrics, Ajou University School of Medicine)
,
Jung, Jo Won
(Division of Cardiology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine)
,
Park, Moon Sung
(Division of Neonatology, Department of Pediatrics, Ajou University School of Medicine)
Survival rates of preterm infants have improved in the past few decades, and central venous catheters play an important role in the intensive medical treatment of these neonates. Unfortunately, these indwelling catheters increase the risk of intracardiac thrombosis, and they provide a nidus for micr...
Survival rates of preterm infants have improved in the past few decades, and central venous catheters play an important role in the intensive medical treatment of these neonates. Unfortunately, these indwelling catheters increase the risk of intracardiac thrombosis, and they provide a nidus for microorganisms during the course of septicemia. Herein, we report a case of persistent bacteremia due to methicillin-resistant Staphylococcus aureus in an extremely low birth weight (ELBW) infant, along with vegetation observed on an echocardiogram, the findings which are compatible with a diagnosis of endocarditis. The endocarditis was successfully treated with antibiotic therapy, and the patient recovered without major complications. We suggest a surveillance echocardiogram for ELBW infants within a few days of birth, with regular follow-up studies when clinical signs of sepsis are observed.
Survival rates of preterm infants have improved in the past few decades, and central venous catheters play an important role in the intensive medical treatment of these neonates. Unfortunately, these indwelling catheters increase the risk of intracardiac thrombosis, and they provide a nidus for microorganisms during the course of septicemia. Herein, we report a case of persistent bacteremia due to methicillin-resistant Staphylococcus aureus in an extremely low birth weight (ELBW) infant, along with vegetation observed on an echocardiogram, the findings which are compatible with a diagnosis of endocarditis. The endocarditis was successfully treated with antibiotic therapy, and the patient recovered without major complications. We suggest a surveillance echocardiogram for ELBW infants within a few days of birth, with regular follow-up studies when clinical signs of sepsis are observed.
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문제 정의
Because the antibiotic susceptibility test of MRSA in our center has shown high rates of resistance to gentamicin, we chose other aminoglycoside, arbekacin as an alternative agent, based on the previous study about the successful treatment of MRSA infection of neonates and infants with arbekacin without significant side effects11). This is the first report of successful MRSA infective endocarditis of preterm infant treated with the antibiotic regimen of arbekacin with vancomycin.
제안 방법
In that 1988 report, the endocarditis was diagnosed by echocardiogram on 25th day of life, and the patient was treated with vancomycin and rifampicin duotherapy. The patient had total resolution of the vegetation on serial echocardiograms and was reported to follow the normal course of development without major complications. In addition, several cases of successfully treated infective endocarditis have been reported in premature infants, with respective infectious agents of methicillin-sensitive S.
대상 데이터
A 960-g male neonate was born at 26 weeks and 5 days of gestation with Apgar scores of 6 and 7 at 1 and 5 minutes, respectively. He was treated with prophylactic endotracheal surfactant in the operation room just after birth, and the chest x-ray revealed a mild degree of respiratory distress syndrome.
참고문헌 (11)
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3 Verhoef J Fleer A Staphylococcus epidermidis endocarditis and Staphylococcus epidermidis infection in an intensive care unit Scand J Infect Dis Suppl 1983 41 56 64 6589762
5 Benner KW Worthington MA Kimberlin DW Hill K Buckley K Tofil NM Correlation of vancomycin dosing to serum concentrations in pediatric patients: a retrospective database review J Pediatr Pharmacol Ther 2009 14 86 93 23055895
6 Armstrong D Battin MR Knight D Skinner J Staphylococcus aureus endocarditis in preterm neonates Am J Perinatol 2002 19 247 251 12152143
7 Poon WB Lian WB Recurrent group B streptococcal septicemia in a very low birth weight infant with infective endocarditis and submandibular cellulitis Ann Acad Med Singapore 2010 39 936 932 21274492
8 Aydemir C Erdeve O Oguz SS Altug N Dilmen U Successful treatment of Candida albicans endocarditis vegetations with recombinant tissue plasminogen activator in an extremely low birth weight preterm infant Mycoses 2011 54 e590 e592 20492524
9 Marks KA Zucker N Kapelushnik J Karplus M Levitas A Infective endocarditis successfully treated in extremely low birth weight infants with recombinant tissue plasminogen activator Pediatrics 2002 109 153 158 11773559
10 American Academy of Pediatrics Committee on Infectious Diseases Staphylococcal infections Pickering LK Baker CJ Kimberlin DW Long SS Red Book: 2012 Report of the Committee on Infectious Diseases 29th ed Elk Grove Village (IL) American Academy of Pediatrics 2012 653 667
11 Yoshida K Minowa H Ebisu R Uchida Y Takahashi Y Yoshioka A Dosage regimen of arbekacin for methicillin-resistant Staphylococcus aureus infection in newborns and infants Pediatr Int 2004 46 645 649 15660861
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