颈深部软组织感染

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,17-7-22,#,小儿颈深部脓肿旳非手术治疗,天津小朋友医院血液科,艾奇,主诉：,间断发烧,20,余天，发觉血小板增,多,1,天。,现病史：入院前,20,余天反复高热,（,T,max,4,0C,），静脉“,头孢硫脒,”,3,天后体温,正常,，停用抗生素，入院,前,12,天再次高热，肌注药物,(,详细不详,),治疗,3,天后体温正常，入院前,4,天起低热，入院前,1,天呈连续高热。门诊,CBC,示,PLT,705,10,9,/,L,。,查体：精神反应好，呼吸平稳，左颈部及数枚蚕豆大小淋巴结，质软，边界清楚，活动度可，心肺腹无异常，神经系统无异常，未见皮疹出血点。,病历摘要,诊治经过：,入院即,拉氧头孢抗,感染,，仍发烧，左颈部见一枚肿物呈进,行性增大，如蚕豆大小，质中,，,触痛,，,BUS,示左颈前胸锁乳突肌,深内侧探及,23mm,13mm,低回声肿块，边界尚清楚，形态不规则，肿块内血流,信号患儿哭闹无法观察，加用利奈唑胺,10mg/kg,次,Q8h,。,入院,3,天体温正常，入院,4,天,MRI,平扫示左侧咽旁间隙软组织肿胀伴其内混杂信号包块，累及咽后壁，左颈部多发肿大淋巴结。复查,BUS,示左颈前胸锁乳突肌深方气管左旁,29mm,21mm,19mm,低回声肿块，内可见,6mm,5mm,无回声区，考虑炎性肿块伴部分液化,。,病历摘要,入院,8,天颈部肿物缩小，,BUS,示原肿块范围约,21mm,12mm,15mm,边界尚清楚，形态不规则,。,入院,10,天，患儿颈部肿物较前变软，较不易扪及，再次发烧，体温达,39,，,更换拉氧头孢为头孢哌酮舒巴坦钠,，继联合应用利奈唑胺,。,入院,13,天体温正常，复查,BUS,示原肿块范围,26mm,27mm,30mm,欠均匀低回声肿块，边界尚清楚，形态欠规则，动态观察可见内容物流动,。,病历摘要,入院,15,天血常规示中性粒细胞,缺乏,。入院,16,天，强化,MRI,示左侧咽旁间隙软组织肿胀，其内包块呈明显不规则强化，边界欠清，,咽后壁区域未见异常强化影，,左颈部多发淋巴结影。停利奈唑胺及头孢哌酮加舒巴坦钠，予阿莫西林克拉维酸钾口服序贯治疗,。,入院,20,天，,BUS,示原肿块范围约,12mm,10mm,欠均匀低回声区，出院,。,出院后口服阿莫西林克拉维酸钾,5,天,，出院,1,周后复查颈,BUS,未探及炎性肿块。血常规正常。,病历摘要,2023-06-23,2023-07-06,拉氧头孢钠,利奈唑按,头孢哌酮舒巴坦钠,阿莫西林克拉维酸钾,Pediatric Otolaryngology for the,Clinician,2023,Preantibiotic era-S.aureus,Currently-aerobic Strep sepsis and non-strep anaerobes,Gram-negative uncommon,Almost always polymicrobial,Remember resistance,Microbiology,Antibiotic,Strengths,Weaknesses,Bactrim,Covers MRSA,Cost effective,Not available as IV,Side effect:Stephen-Johnson syndrome,Clindamycin,Covers MRSA,Good Gram+/,anaerobic coverage,IV/PO,Increasing resistance,Erythromycin-inducible clindamycin resistance(need d-test),Side effect:C dificile enterocolitis,Ampicillin-sulbactam,Good Gram+/coverage,Can switch to,ampicillin/,sulbactam for PO,MRSA not covered,Vancomycin,MRSA coverage,Not available as PO,Nephrotoxicity,Must check levels,Side effect:red man,syndrome,Linezolid,IV/PO,Covers MRSA,Expensive,Side effect:neutropenia,thrombocytopenia,Empiric therapy for deep space neck infections,Pediatric Otolaryngology for the,Clinician,2023,Thanks,