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乳兒(滿1年未滿)葡萄狀球菌感染에 關한 臨床 및 細菌學的 考察

Clinical and Bacteriological Study on Staphylococcal Infection in Infants

대한의학협회지 1963년 6권 5호 p.521 ~ 530
이근수 (  ) - 국립의료원 소아과

Abstract


Staphylococcal infection is the second in frequency to E. coli as a cause of infection in the newborn, Staphylococcus aureus has assumed relatively greater importance in recent years, owing to ability of the organism to become risistant to most of the commonly used antibacterial agents. Teh causative organism may already be resistant to one or more antibiotics, or it may become resistant during the course of therapy. The auther had collected 49 cases of staphylococcal infection in infant below one year of age and clinical and bacteriological stduies have been carried out.
The results were as follows:
The peak of age incidence in month was one month of age. There were 24 cases of staphylococcal pneumonia, 7 cases of staphylococcal enteritis cmoplicated with staphylococcal skin infection, 5 cases of staphylococcal pyoderma and 4 cases of staphylococcal empyema most probaly post pneumonic type. Among the 24 cases of staphylococcal pneumonia 5 cases developed typical "soap bubble" or pneumatocele on X-ray which are almost pathognomonic of staphylococcal pneumonia. The presence of those "soap bubble" was little associated with respiratory distress, and even large ones had surprisingly little effect on the clinical picture presented by those infants. None of them produced empyema or pneumothorax. In one infant pneumatocele disappeared in 4 weeks, shile the other protracted case it persisted for more than 5 months. Pneumonic infiliration were ween more on the right lung than the left.
Since the number of bacterial sensitivity test was too small in author´s series, special reference to bacterial sensitivity test performed for 800 hospital strains of Staphylococcus aureus at the National Medical Center during the year of 1961 were made. Among 800 hospital strains of Staphylococcus aureus,
99.7% were resistant to sulfathiazol,
97.0% were resistant to penicillin,
77.7% were resistant to streptomycin,
36.3% were resistant to tetracyclin,
18.1% were resistant to chlormycetin,
34.1% were resistant to aureomycin,
36.7% were resistant to terramycin,
2.2% were resistant to neomycin,
9.2% were resistant to erythromycin.
The mean durations of chloromycetin and erythromycin medication for author´s cases were 10 days and 24 days respectively. The mean duration of antibiotic therapy for staphylococcal pneumonia was about 26 days. Relapse or further progression of pneumonia has occurred in one patient who showed marked clinical improvement, but in whom antibacterial therapy was discontinued prematurely.
The total duration of antibiotic therapy for staphylococcal pneumonia should be sbout 5 to 6 weeks. In general, it si best to consider any case of pneumonia or undetermined severe respiratory disease in infancy as potentially staphylococcal in origin, and to make every effort to determine the character and susceptibility of the paghogen. It should be attacked immediately with intensive antibiotic therapy, and symptoms, signs, and X-ray evidence should be followed closely so that complications may be detected and treated promptly.

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