Pediatric Infection and Vaccine

  • 제30권3호
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  • Pages.152-158
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  • 2023
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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The First Neonatal Case of Panton-Valentine Leukocidin-Positive Staphylococcus aureus Causing Severe Soft Tissue Infection in Korea

  • You Hoon Kim (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Seung Hyun Shin (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Hyeri Seok (Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Dae Won Park (Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Young Hwan Park (Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Yoonsun Yoon (Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Yun-Kyung Kim (Department of Pediatrics, Korea University College of Medicine)
  • 투고 : 2023.09.14
  • 심사 : 2023.10.30
  • 발행 : 2023.12.25
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초록

황색 포도알균은 흔한 피부 및 연조직 감염의 원인이며, panton-valentine leukocidin (PVL) toxin 생산 황색 포도알균은 전 세계적으로 발견되고 있으며 심각한 감염을 일으키는 것으로 알려져 있다. 그러나, PVL 양성 황색 포도알균으로 인한 신생아 감염은 매우 드물다. 저자들은 생후 7일 신생아에서 발견된 PVL 양성 황색 포도알균 감염으로 인한 심한 피부, 연조직 감염 사례를 보고하고자 한다. 환자는 당일 발생한 발열, 2일 전 시작된 둔부 열감, 부종, 압통으로 응급실로 내원하였다. 내원 당일, 발열, 빈맥, 전신 컨디션 저하, 둔부의 열감과 압통 진행이 확인되었다. 초음파 및 자기공명영상검사에서 피부 및 연조직, 일부 근육을 침범한 괴사성 근막염이 확인되었다. 둔부 병변에서 배농한 검체에서 PVL 양성 메티실린내성 황색포도알균 (MRSA)이 배양되었고, 균혈증은 없었다. 환자는 한달 간의 정맥 항생제 투여와 외과적 배액 수술 후 회복되었다. 퇴원 한달 후, 환자는 외이도염으로 재입원, 피부에서 동일한 MRSA가 확인되었다. 병변은 정맥 항생제 투여 및 소독만으로 호전되었다. 환자는 0.5% 클로르헥시딘 목욕을 통해 탈집락화(decolonization)를 시행하였고, 회복 후 재감염은 없었다. 본 사례는 PVL 생산 황색 포도알균 감염에 대해 적극적인 배액 수술 및 항생제 치료가 필수적이며, 재발 및 지역사회 확산을 방지하기 위해 추가적인 탈집락화가 필요함을 시사한다.

Staphylococcus aureus (SA) is a common cause of skin and soft tissue infections. Panton-Valentine leukocidin (PVL) toxin-producing strain of SA has been discovered worldwide and is known to cause serious infections. However, reports of neonatal infections caused by PVL-positive SA are rare. Here, we report a case of severe skin and soft tissue infection caused by PVL-positive SA in a 7-day-old neonate. The patient was admitted to the emergency room with a history of fever for one day, tenderness, and sensation of buttocks heating. The infant presented with fever, tachycardia, poor general health, progressive tenderness, and edema of the buttocks on the day of admission. Ultrasonography and magnetic resonance imaging revealed necrotizing fasciitis involving the skin, soft tissue, and muscles. Specimens drained from the buttock lesions confirmed the presence of PVL-positive methicillin-resistant SA (MRSA), and there was no bacteremia. She recovered after one month of intravenous antibiotics and surgical drainages. One month after discharge, she was rehospitalized for otitis externa and was infected with MRSA again. Considering the PVL-positive strain, the patient was treated with intravenous linezolid and dressing. The patient underwent decolonization therapy in a 0.5% chlorhexidine bath and recovered completely without sequelae. This case suggests that aggressive drainage and antibiotic treatment are essential for PVL-producing MRSA infections, and additional decolonization is needed to prevent recurrence and community spread.

키워드

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