关注非结核性分枝杆菌致皮肤和软组织的感染

目的 对国内外有关非结核性分枝杆菌致皮肤软组织感染，在美容医学和整形外科中的发生病因学、诊断、菌种鉴别和防治原则进行综合分析。方法 经计算机检索PubMed数据库、中国期刊全文数据库，检索1983年至2006年的相关文献并进行归纳。对美容医学和整形外科中发生非结核性分枝杆菌皮肤软组织感染的文献进行评述。结果 在国内外的美容整形外科领域，如假体隆乳术、乳房缩小术、乳房提升术、脂肪抽吸术、面部提升术、重睑成形术、药物注射等，因非结核性分枝杆菌引起的局部感染有增加趋势，已引起人们的关注。结论 非结核性分枝杆菌的皮肤软组织感染是可以治愈的。在临床中，只要做到早期诊断和早期处理。就能有效地控制感染的发生。     

非结核性分枝杆菌所致手部感染

自从人类发现并使用抗生素以来，引起手部感染的菌群一直在不断发生着一些重要的变化。本文将重点介绍的是近年来不断受到关注的非结核性分枝杆菌所致的手部感染。本病尤其多见于沿海地区经常接触海洋生物或海上作业的人群中，流行病学资料也显示沿海地区分枝杆菌感染率较其它地区高。这里指出的是在沿海地区，尤其是从事渔业的人群当中，除了非结核性分枝杆菌感染较常见，还有许多其它特殊菌群所致手部感染，如非霍乱性弧菌，另外就是伤后继发的各种细菌感染。而且就分枝杆菌的自然分布而言，海水分枝杆菌除了广泛存在于海洋，也同时存在于淡水中。另外几种非结核性分枝杆菌的分布则根本没有沿海与内地的分别。     

皮肤和软组织感染的治疗

皮肤细菌感染较为常见,其程度可由轻至重度(危及生命)不等。严重的皮肤感染及其处理和预后取决于感染机理、皮肤结构和致感染微生物。原发性皮肤感染的病因是微生物由表皮、细微裂口侵入或经血流扩散。继发感染来自创伤、烧伤或手术伤口,有关皮肤软组织感染亦进行了讨论。对病因、细菌学因素和皮肤感染的处理进行了研究,尤其着重于脓皮病、糖尿病患者的足部感染和坏死性软组织感染。抗生素的选择在很大程度上取决于感染菌种或抗菌类型,在坏死性软组织感染,其治疗依赖于外科手术。在上述情况和某些晚期皮肤感染,应采用非肠道抗生素。本文讨论替卡西林二钠与克拉维钾联合应用的效果。     

注射溶脂致非结核分枝杆菌感染11例临床分析

目的：了解与注射溶脂相关的非结核分枝杆菌(Nontuberculous?mycobacteria,NTM)皮肤及软组织感染临床特点，总结治疗经验。方法：对2020年12月-2021年2月收治的11例注射溶脂术后出现NTM感染患者的临床资料（临床特点、微生物学检查、治疗方法及疗效）进行回顾性分析。结果：感染出现症状的中位时间为14?d，微生物学检查发现，5例快生长非结核分枝杆菌感染，3例NTM与其他病原体合并感染，采取综合治疗方案，11例感染均得到治愈。结论：早期识别注射溶脂术后并发NTM感染十分重要，相关微生物学检查可以明确诊断，采取综合治疗方案可以有效控制感染症状，最大限度的保护正常组织，避免容貌损害。     

非结核性分枝杆菌肺感染病及肺结核未确诊一例

结核分枝杆菌导致的肺结核是呼吸系统常见病。非结核性分枝杆菌（nontuberculosismycobacteria,NTM）是指结核分枝杆菌和麻风分枝杆菌以外的所有分枝杆菌。NTM是一类环境微生物,为条件致病菌。非结核分枝杆菌病指人类感染NTM并引起相关组织或脏器的病变,全国报道上百例非结核性分枝杆菌病,该病属于罕见病例。     

肝硬化合并皮肤软组织感染研究进展

肝硬化患者因其免疫力低下、下肢水肿等原因是皮肤软组织感染的高危人群,常见的皮肤软组织感染部位为下肢,常见的感染类型为蜂窝织炎。与一般人群不同,肝硬化患者合并皮肤软组织感染的病原体以革兰阴性杆菌为主。血清肌酐值和MELD评分为肝硬化患者合并皮肤软组织感染预后不良的预测因素。我国肝硬化患者合并皮肤软组织的病原学与临床特征尚需进一步明确,旨在为优化此类患者的优化管理提供一定的依据。     

非结核性分支杆菌感染的外科治疗

我院于１９９６年６～１０月收治非结核性分支杆菌（ＮＴＭ）感染患者４６例，报告如下。１．临床资料：本组４６例，男性１５例，女性３１例；年龄３～６３岁，平均２５－６岁。均因接受同一批注射器注药，导致臀部久治不愈的感染。患者发病缓慢，从局部注射到发病潜伏期１４～７５天，平均２８－５天。全身症状较轻，２１例有低热，体温３８～３８－５℃，精神食欲差；１６例有全身关节痛；５例轻度贫血，血红蛋白平均７－８ｇ／Ｌ，血白细胞通常不高。患者在接受臀部注射后，注射部位逐渐出现硬结、疼痛、压痛、红肿、穿破流脓。脓液稀薄…     

大面积皮肤软组织缺损伴严重感染创面的修复

目的探讨大面积皮肤软组织缺损感染创面的修复方法。方法对15例大面积皮肤软组织缺损伴创面严重感染的患者，经积极换药后均行两次清创手术，首先采用异体皮片移植暂时覆盖创面，再行自体皮肤移植或皮瓣转移修复创面。结果术后经6个月至4年的随访，自体的皮肤和皮瓣移植后均完全成活，创面修复良好。患者平均住院时间38d。结论两次彻底清创和异体皮片移植暂时覆盖创面是修复大面积皮肤软组织缺损严重感染创面的有效方法，值得推广应用。     

大面积皮肤软组织缺损伴严重感染创面的修复

目的探讨大面积皮肤软组织缺损感染创面的修复方法。方法对15例大面积皮肤软组织缺损伴创面严重感染的患者,经积极换药后均行两次清创手术,首先采用异体皮片移植暂时覆盖创面,再行自体皮肤移植或皮瓣转移修复创面。结果术后经6个月至4年的随访,自体的皮肤和皮瓣移植后均完全成活,创面修复良好。患者平均住院时间38d。结论两次彻底清创和异体皮片移植暂时覆盖创面是修复大面积皮肤软组织缺损严重感染创面的有效方法,值得推广应用。     

右小腿软组织结核性脓肿1例报告

近年来,由于结核病急剧回升,有关肺外结核也有增多趋势,肺外结核在骨与关节最为多见,发生于四肢软组织(包括肌组织及肌腱等)的结核少见,但亦有少量个案报道[1-2],临床易误诊误治,本科近日收治1倒,报告如下. 1临床资料 1.1病案报告 患者,女性,23岁,农民工.因“右小腿肿痛半年,包块形成3个月”于2011年4月29日入院.患者半年前曾在非医疗机构行右小腿局部“埋线减肥”,无结核病史.因有此侵入性操作,一直认为是埋线后的正常反应,自行口服抗生素治疗,直到3个月前出现包块并进行性增大才就医.     

40例水痘合并皮肤及软组织感染的临床分析

目的探讨水痘合并皮肤及软组织感染的临床特征、细菌学特点以及预后等。方法对本院2007年1月至2010年1月收治的40例水痘合并皮肤及软组织感染病例进行回顾性分析。结果入组患者中,水痘皮肤及软组织感染发生率35.4%(40/113),为住院患者最主要的并发症。溶血性链球菌、金黄色葡萄球菌是水痘患者继发皮肤及软组织感染最常见病原菌。脓毒症休克是死亡的主要原因。本组水痘合并皮肤及软组织感染的患者无一进行水痘免疫接种。存活组和死亡组患者的白细胞(WBC)、血小板(PLT)PLT、丙氨酸氨基转移酶(ALT)、血清白蛋白(ALB)、凝血酶原活动度(PTA)、血肌酐(Cr)、C-反应蛋白(CRP)等指标差异具有统计学意义(P<0.05)。结论水痘合并皮肤及软组织感染者病死率仍较高,积极进行脓毒性休克的预防及治疗尤为关键,接种水痘疫苗可能是从根本上降低并预防水痘并发症的重要举措。     

Necrotizing soft tissue infections

Necrotizing soft tissue infections (NSTI) represent a spectrum of diseases characterized by extensive rapidly progressive necrosis that may involve the skin, subcutaneous tissues, fascia or muscle. Their progress is extremely fast, leading often to sepsis and septic shock that ends up in multiple organ failure with abrupt and high mortality. A variety of classification systems have been developed based on parameters such as anatomic location of the disease or microbiology. There are a number of factors that predispose to the spread of these soft tissue infections, such as delays in recognition, immune suppression, diabetes mellitus and advanced age. The use of broad‐spectrum antibiotics tends to mask the severity of the underlying infection, modulates the clinical presentation, and even delays hospital admission. The most important factor affecting outcome in NSTI is early diagnosis and aggressive radical surgical treatment. The medical records of 13 patients who had been treated for NSTI from 1996 to 2005 were reviewed, retrospectively. There were eight men (61.5%) and five (38.5%) women. Mean age was 56 years (range 27–73). Seven cases of infection involved the perineal region (54%), two the lower limb, one the upper limb and three the abdominal wall/trunk. The most common associated comorbidity was diabetes mellitus in five patients (38.5%). A single organism was identified in two (15%) and multiple organisms in 11 (85%) patients. Necrotizing aponeurositis Type I was the most common of the polymicrobial necrotizing infections. Overall survival was 85%, and the mean hospital stay for survivors was 35 days (range 17–92).     

Emergence of community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections as a common cause of hospitalization in United States children

Background

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) was first observed in pediatric patients in the late 1990s. Since then, possible risk factors for contracting CA-MRSA have been hypothesized, but supporting studies are limited.

Methods

We analyzed hospital discharge records for patients with a principal International Classification of Diseases, Ninth Revision code for skin and soft tissue infections, collected from 1996 to 2006 by the United States National Center for Health Statistics. Noninstitutional, short-stay hospitals in the United States participated. The sample was limited to patients aged ≤19 years. Staphylococcus aureus and CA-MRSA were defined by International Classification of Diseases, Ninth Revision codes. Data weights were used to derive regional and national estimates. Population estimates were obtained from the US Bureau of the Census, and incidence rates were reported per 100,000 persons. Risk factors for CA-MRSA were first identified using χ² and χ² goodness-of-fit tests, then by multivariable logistic regression.

Results

These data represent 616,375 pediatric discharges for skin and soft tissue infections from U.S. hospitals between 1996 and 2006. This represents approximately 69.9 hospitalizations for skin and soft tissue infections per 100,000 U.S. children per year. Staphylococcus aureus and CA-MRSA accounted for 19.6% and 9.6% of these cases, respectively. The rate of hospitalization for CA-MRSA skin and soft tissue infections increased dramatically over the study period; from less than one case per 100,000 in 1996 to 25.5 cases per 100,000 in 2006. Rates of CA-MRSA varied by region, with the South region having the highest rate (11.5 per 100,000 US children), followed by the West (5.2), Northeast (3.4), and Midwest (3.2). Peak CA-MRSA incidence occurred from May to December; however, the incidence in the South region was consistently higher than other regions for most months and the period of peak incidence was longer than other regions. Independent risk factors for CA-MRSA included survey year, race, geographic region, hospital size, and health insurance status (P < .0001 for all risk factors).

Conclusions

Pediatric hospitalizations for methicillin-susceptible S. aureus and CA-MRSA skin and soft tissue infections are on the rise. Possible risk factors for CA-MRSA infection include White race, residence in the South region of the United States, and lack of health insurance.     

Prospective observational study to assess the need for postoperative antibiotics following surgical incision and drainage of skin and soft tissue abscess in pediatric patients

Background

Post-operative antibiotics are often utilized for skin and soft tissue infection (SSTI) requiring surgical incision and drainage (I&D). We propose that antibiotics are unnecessary following I&D.

骨外露及皮肤软组织缺损的修复

目的　评价和探讨修复骨外露及皮肤软组织缺损的各种方法 ,使其更好地用于临床。方法　 3 5例不同部位的骨外露分别采用皮片移植、皮瓣及肌皮瓣转移、皮瓣及肌皮瓣游离移植等方法 ,覆盖外露的骨面。结果　 3 1例全部存活 ,1例皮瓣部分坏死 ,2例创口延迟愈合 ,1例游离皮瓣失败。结论　对骨外露及皮肤软组织缺损应尽量在早期修复 ,最常用的方法是皮瓣及肌皮瓣的转移或移植。     

Increasing national burden of hospitalizations for skin and soft tissue infections in children

Background

The number of children requiring treatment of skin and soft tissue infections (SSTIs) has increased since the emergence of methicillin-resistant Staphylococcus aureus.

Methods

The 2000, 2003, and 2006 Kids' Inpatient Databases were queried for patients with a primary diagnosis of SSTI. Weighted data were analyzed to estimate temporal changes in incidence, incision and drainage (I&D) rate, and economic burden. Factors associated with I&D were analyzed by multivariable logistic regression.

Results

Pediatric SSTI admissions increased (1) in number, (2) as a fraction of all hospital admissions, and (3) in incidence per 100,000 children from the years 2000 (17,525 ± 838; 0.65%; 23.2) to 2003 (27,463 ± 1652; 0.99%; 36.2) and 2006 (48,228 ± 2223; 1.77%; 62.7). Children younger than 3 years accounted for 49.6% of SSTI admissions in 2006, up from 32.5% in 2000. Utilization of I&D increased during the study period from 26.0% to 43.8%. Factors most associated with requiring I&D were age less than 3 years and calendar year 2006 (both P < .001). Hospital costs per patient increased over time and were higher in the group of patients who required I&D ($4296 ± $84 vs $3521 ± $81; P < .001; year 2006). Aggregate national costs reached $184.0 ± $9.4 million in 2006.

Conclusion

The recent spike in pediatric SSTIs has disproportionately affected children younger than 3 years, and an increasing fraction of these children require I&D. The national economic burden is substantial.     

应用改良扩张器构建大鼠皮肤软组织扩张模型

目的应用改良设计的短注射导管枕形扩张器构建大鼠皮肤软组织扩张模型，并探讨其产生的扩张应力对大鼠皮肤细胞增殖分化的影响，验证扩张模型的扩张效果，为研究扩张皮肤新生机制提供一个稳定的动物模型。方法SD大鼠随机分为A、B两组（每组各30只），A组大鼠采用改良设计的扩张器，B组大鼠采用上海威宁公司生产的普通扩张器；选择SD大鼠近颈部切口，以注射壶外置的方式埋置扩张器，制作皮肤软组织扩张模型。分别采集A组在不同扩张时间点（1、2、3、4、5周）的扩张中心区域皮肤和正常皮肤组织作为标本；利用HE染色方法观察扩张后皮肤结构的变化；根据增殖细胞表达增殖细胞核抗原，采用免疫组织化学染色方法观察扩张皮肤中细胞增殖的情况。结果A组应用自行改良设计的扩张器，选择大鼠近颈部切口构建的皮肤软组织扩张模型，术后外置的注射壶不易被大鼠咬掉，且术后注水及护理更简单，模型稳定性显著高于B组。HE染色结果表明，扩张后皮肤的表皮层明显增厚，真皮层变薄；免疫组织化学染色结果显示，增殖细胞呈点状分布，主要集中于表皮基底层和毛囊鞘。结论自行改良设计的短注射导管枕形扩张器，是构建大鼠皮肤软组织扩张模型的良好实验材料；扩张应力对大鼠的皮肤结构和增殖产生了影响。     

腹部皮肤软组织扩张术的效果观察

目的：讨论腹部皮肤软组织扩张的规律和效果。方法：选取2009年2月至2010年6月入院接受腹部扩张器置入术的3例患者,埋置腹部扩张器5枚,定期注水扩张。于注水末期行腹部CT扫描。将CT扫描结果导入Mimics 10.01软件,测量模拟原腹部轮廓至扩张器内、外界的距离并比较二者大小。结果：在注水末期,2枚扩张器向外扩张距离明显大于向内扩张,1枚向内扩张距离明显大于向外扩张,2枚向内、外扩张的距离相近。结论：腹部皮肤软组织扩张术仍是获得＂额外＂皮肤的有效手段,但对扩张过程中皮肤增加规律尚需进一步研究明确,以利于提高扩张效率、预防潜在并发症。