Neonatal methicillin-resistant Staphylococcus aureus pneumonia-related recurrent fatal pyopneumothorax: A case report and review of literature  

作　　者：Xing-Chao Li Li Sun Tao Li 

机构地区：[1]Department of Pediatrics,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei Province,China [2]Institute of Pediatric Research,Hubei University of Medicine,Shiyan 442000,Hubei Province,China [3]Institute of Pediatric Research,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei Province,China

出　　处：《World Journal of Clinical Cases》2023年第30期7475-7484,共10页世界临床病例杂志

基　　金：Supported by the Scientific and Technological Project of Shiyan City of Hubei Province,No.21Y32;the Medical Research Project of Hubei Pediatric Alliance,No.HPAMRP202114.

摘　　要：BACKGROUND Although neonatal Staphylococcus aureus pneumonia is common and usually curable,it can also be refractory and life-threatening.Herein,we report a case of severe neonatal community-acquired methicillin-resistant Staphylococcus aureus(CA-MRSA)necrotizing pneumonia with bilateral recurrent pyopneumothorax,respiratory failure,heart failure,and cardiac arrest.We hope our report will add to the understanding of this disease.CASE SUMMARY An 18-d-old boy presented with cough for five days,fever for three days,and dyspnea for two days.Preadmission chest radiograph revealed high-density shadows in both lungs.On admission,his oxygen saturation fluctuated around 90%under synchronized intermittent mandatory ventilation.He was unconscious,with dyspnea,weak heart sounds and hepatomegaly.Moist crackles were present throughout his left lung,while the breath sounds in the right lung were decreased.After high-frequency oscillatory ventilation,empiric antimicrobials(meropenem and vancomycin),improved circulation,and right pleural cavity drainage for right pneumothorax(approximately 90%compression),his oxygen saturation level stayed above 95%,and recruitment of the right lung was observed.His condition did not deteriorate until the 5th day of hospitalization(DOH 5).On the morning of DOH 5,his oxygen saturation decreased.Subsequent chest radiograph showed bilateral pneumothorax with nearly 100%compression of the left lung.Desaturation was not relieved after urgent left pleural cavity drainage,and cardiac arrest occurred soon thereafter.Although his spontaneous heartbeat returned through emergency resuscitation and salvage antibacterial therapy(linezolid and levofloxacin)was administered given the detection and antimicrobial susceptibility of MRSA,he showed no improvement,with recurrent pyopneumothorax and continued drainage of purulent fluid and necrotic lung tissue fragments from the pleural cavity.Eventually,his parents refused extracorporeal membrane oxygenation(ECMO)and gave up all the treatments,and the newborn passed

关 键 词：NEWBORN Methicillin-resistant Staphylococcus aureus PYOPNEUMOTHORAX LINEZOLID Extracorporeal membrane oxygenation Case report 

分 类 号：R969[医药卫生—药理学]