Staphylococcus aureus in an infant.

Staphylococci are widely distributed in the environment and can be represented by both opportunistic and pathogenic microorganisms. The greatest pathogenicity has Staphylococcus aureus, capable of causing the development of purulent inflammatory processes in various organs and tissues. Especially dangerous staphylococcus aureus in infants - primarily due to incomplete child immune defense. What do you need to know about this bacterium, and what steps should be taken if there are positive test results in the baby?

Epidemiology

According to statistics, in every third child on the skin or mucous membranes can be found staphylococcus aureus. As a rule, it is a carrier infection, which, however, can later enter the body and provoke the development of various pathologies - from furunculosis to pneumonia and even sepsis. [1]

The bacterium is most frequently detected in children in the first year of life. The degree of isolation gradually decreases with age. The pathogen is isolated mainly from the mucous membranes of the nasal cavity and tonsils, but other localizations occur. [2]

Staphylococcus aureus causes more than 60% of existing staphylococcal infections. Saprophytic and epidermal Staphylococcus aureus are somewhat less common. [3]

Causes of the staphylococcus aureus in a newborn.

Staphylococcus aureus may well live in the body of any person - but only in small quantities. Active multiplication of bacteria begins against the background of a sharp weakening of immune defense, or other stress factors. [4]

Infants are the most susceptible to active growth and infection. Young children do not yet produce the necessary antibodies, and their immunity is weak and incomplete.

Staphylococcus aureus in an infant can occur:

• Infection from your own mother - for example, during childbirth or breastfeeding;
• from health care workers at the maternity hospital, hospital, outpatient clinic;
• by direct contact with a sick person (carrier);
• Contact with objects infected with Staphylococcus aureus (toys, utensils, etc.).

Risk factors

At-risk groups typically include:

• babies born prematurely;
• babies who have been on artificial nutrition since birth;
• Weak infants who are underweight;
• children with congenital defects and diseases;
• Infants who have been treated with antibiotics, hormones, or children with diagnosed intestinal dysbacteriosis;
• Babies living in unfavorable sanitary conditions, with poor hygiene standards, on the background of poor nutrition.

Pathogenesis

Staphylococcus aureus is one of the most pathogenic varieties of such bacteria. However, the presence of this microbe in healthy human microflora is not excluded.

Staphylococcus aureus received such an unusual name because of its ability to form a specific pigmented substance, which, when examined microscopically, is characterized by a characteristic orange-yellow hue. This bacterium is resistant to drugs, can "survive" boiling, exposure to ultraviolet light, prolonged drying. It is not affected by strong salt solutions and hydrogen peroxide, so the bacterium lives and multiplies perfectly in almost any conditions. [5]

Staphylococcus aureus has pronounced enzymatic activity and secretes:

• lipase, which breaks down fats, allowing the bacteria to easily cross the skin barrier and enter the bloodstream;
• coagulase, which helps create a defense of the bacterium against immune cells;
• penicillinase, which provides resistance of the bacterium to penicillin drugs.

In addition, Staphylococcus aureus excretes endo- and exotoxic substances that cause severe intoxication. This microbe shows strong resistance to drugs, prone to frequent mutation, so it is quite difficult to get rid of it.

Methicillin-resistant Staphylococcus aureus is considered one of the most unfavorable mutations of the microbe: it occurs predominantly as an intrahospital infection.

How is staphylococcus aureus transmitted to an infant?

A child can contract Staphylococcus aureus anywhere - at home, on the street, from his or her own mother, and from certain foods or water.

Since the bacterium is very resistant, it is often found in hospitals and clinics: if all existing sanitation standards are observed, the microbe is able to mutate to such an extent that it becomes resistant to almost any treatment solutions. [6]

There are several known ways in which Staphylococcus aureus can get to the infant:

• household contact method - is the transmission of infection through bacteria-contaminated objects (toys, underwear, towels, utensils, etc.);
• Droplet-air method - involves airborne transmission of bacteria through coughing, sneezing, etc.;
• fecal-oral method - is the spread of germs through unwashed hands, mother's breasts (when breastfeeding);
• vertical route - involves the transfer of infection to the baby from its mother during pregnancy or during labor (when passing through the birth canal).

Another possible transmission option is the consumption of mother's milk by the baby if the mother has infectious mastitis.

Symptoms of the staphylococcus aureus in a newborn.

Staphylococcus aureus in the active stage usually reveals itself with these symptoms:

• the infant has a high fever;
• the telltale signs of rhinitis;
• the child is lethargic, cranky, refuses to eat, cries;
• there may be bouts of nausea and vomiting;
• there's a cough;
• swollen and red eyes, possible tearing;
• stools become unstable (alternating periods of constipation and diarrhea);
• the baby loses weight (primarily due to loss of appetite);
• the balance of intestinal microflora is disturbed);
• the skin is covered with rashes and other pathological elements, - these may be pimples, pustules, itchy nodules, areas of flaking.

The incubation period for the activation of Staphylococcus aureus can be from 3 hours to 4-5 days. In this case, it is possible to accurately identify the causative agent only after a culture.

The norm of staphylococcus aureus in an infant

Staphylococcus aureus can be found on the skin and mucous membranes of the infant, as well as in the intestines, nasal cavity, tonsils. With any suspicion of infection, the infant is analyzed, which will accurately indicate whether there is pathology or not.

Determining the presence and abundance of Staphylococcus aureus may be necessary in order to assess the need for treatment: if the bacterial count is within acceptable limits and there are no clinical symptoms, no treatment is necessary. For example, Staphylococcus aureus in the intestinal cavity can be found in almost all cases and is not a reason for therapy. However, if the number of bacteria is exceeded, then it is necessary to take action, otherwise unpleasant pathological signs in the form of infectious colitis, colic and other digestive disorders will follow.

The presence of Staphylococcus aureus does not always indicate an infectious lesion, as it may be an asymptomatic carrier. A smear from the nasal cavity and pharyngeal mucosa with a determination of the number of microbes up to^{103 is considered} a common non-pathological carrier. Exceeding this indicator can cause the development of infectious and inflammatory diseases. In children older than 1 year, the norm is slightly higher - up to^104.

The mere presence of Staphylococcus aureus alone cannot be a reason for prescribing drug therapy.

Staphylococcus aureus numbers should be determined before the start of treatment and after its completion. Further monitoring of the number of bacteria is required for a couple of months after the therapeutic course. [7]

Staphylococcus aureus in the feces of an infant

A stool test can be administered to the baby already in the maternity hospital if staphylococcus aureus is suspected. The fecal masses are analyzed at least twice - for example, one or two days apart. Material for analysis is provided to the laboratory as early as possible - preferably immediately after emptying the intestine, but no later than 3 hours after it. This timing directly affects the correctness of the results.

The limit for staphylococcus aureus in feces can be¹⁰³,¹⁰⁴.

Even if the indicator of the number of bacteria is within the normal range, the doctor will advise to observe its dynamics, because it is possible that the infection will continue to multiply rapidly, which will require urgent treatment. If the number of golden staphylococci will not change significantly, then we can talk about the normal state of health of the baby.

Staphylococcus aureus skin manifestation in newborns

Staphylococcus aureus is able to manifest itself in any organ and on any tissue of the human body. And this is the particular danger of the bacterium.

Skin manifestations in children can be different, depending on the form of staphylococcus aureus lesion:

• Staphylococcal folliculitis is manifested by an inflammatory process at the top of the hair follicles: the skin around the follicle becomes red, a pustule or pustule is formed, which after opening reveals a crust or ulcer. A fairly large area may be affected, mainly in the face or scalp.
• Staphylococcal hidradenitis is an inflammation of the sweat glands, which can be found almost anywhere on the body. There are pustules (pimples), areas of swelling.
• Furuncles are usually painful, can affect the face, back, neck area. Carbuncles are more complex elements: the affected skin areas become livid, specific purulent funnels are formed, temperature may rise.

Even with the detection of these pathological signs, treatment of the infant is not carried out until the results of the tests: it is imperative to make sure that the violation of the skin is not caused by other unfavorable factors.

Staphylococcus aureus in a baby's nose

Staphylococcus aureus is often isolated precisely from the nasal cavity, but not always its presence indicates the presence of a disease. Only on the background of exceeding the permissible indicators appear the first signs of infection:

• whitish or greenish-yellow discharge;
• elevated temperature, fever;
• signs of general intoxication;
• General disorder, headaches, nausea, loss of appetite.

In the future, Staphylococcus aureus can become a trigger for the development of such pathologies as sinusitis, frontitis. The pathological condition is aggravated by frequent and uncontrolled use of nasal vasoconstrictors, self-treatment with antibacterial agents, incomplete or incorrect course of antibiotic therapy.

Complications and consequences

Staphylococcus aureus in an infant is capable of provoking a generalized pathological process, since the microbe can spread freely, affecting many tissues and organs. In this case, the danger exists even with an initial small manifestation of the disease on the skin: in the absence of treatment in a short time develops a baby phlegmon, which is a purulent-inflammatory reaction in the fatty tissue, with the further formation of a necrotic process. [8]

In cases where the infectious carrier is the child's mother, Staphylococcus aureus can easily penetrate into the child's intestinal cavity (this occurs during breastfeeding). Such a mechanism causes serious disorders in the digestive tract. As a consequence, the growth and development of the baby is disturbed.

In addition, Staphylococcus aureus from the tissues can penetrate into the bloodstream, with the further development of an extensive pathologic process: we are talking about septic complications that threaten the life of the infant. [9]

Diagnostics of the staphylococcus aureus in a newborn.

Diagnostic measures to detect Staphylococcus aureus primarily involve the use of serologic tests, viz:

• a commonly used in vitro coagulase assay, the duration of the test is four to 24 hours;
• Latex-agglutination reaction, using latex particles coupled with antibodies to Staphylococcus aureus (meaning A-protein, adhesion factor and a number of surface antigens).

In addition, the following tests may be useful in diagnosis:

• General clinical examination of blood and urinary fluid (in staphylococcal infection in the blood determine the increased content of leukocytes and neutrophils, accelerated COE, and in the urine found protein, leukocytes and staphylococci);
• biological seeding on an appropriate nutrient medium.

Stool culture is necessary to identify the infectious agent and to determine its sensitivity to antibiotic therapy. Fecal culture is possible no later than 3 hours after defecation. Swabs from the oral cavity and nasopharynx are taken before eating and taking any medications.

In case of skin lesions, it is relevant to take a smear from the affected areas, after mechanical cleaning and treatment of the wound surface with antiseptic preparations.

Instrumental diagnosis involves the use of such procedures:

• The agglutination reaction is performed to clarify the dynamics of pathology and to assess the effectiveness of selected therapy. The study is repeated at least twice with an interval of 1-1.5 weeks. If the antibody titers in the blood increase and exceed 1:100, it indicates that the infection is progressing.
• Phagotyping of plasma-coagulating Staphylococcus aureus helps to determine the degree of sensitivity of microorganisms to viral phages, for further selection of therapeutic measures.

Differential diagnosis in the laboratory is made with streptococcal infection.

Treatment of the staphylococcus aureus in a newborn.

If the number of Staphylococcus aureus in the body of an infant exceeds the permissible indicators, then it is necessary to treat the pathology under the control of a doctor, following all his instructions. Additionally, parents can take the following measures:

• bathe the child in herbal decoctions (decoctions and infusions of chamomile, sage, calendula are suitable);
• give the baby complex preparations such as Baby Calm or Plantex, which facilitate digestive processes, improve intestinal function, stimulate enzyme secretion;
• play with the child more often, stimulating his/her motor activity;
• do light exercises and abdominal massage.

The mother herself, breastfeeding, should monitor her own hygiene, as well as review her diet. It is desirable to exclude from the menu rice, peas and beans, cabbage, grapes and blueberries. Such recommendations are especially relevant if staphylococcus aureus is found in the stool of an infant.

The basic directions in the treatment of the baby should be to strengthen the body's protective response and stabilize metabolic processes. It is very important that lactation is not interrupted, as breast milk is the main factor of healthy infant immunity.

If the infant shows symptoms of the inflammatory process, there are changes in stool, fever, then the doctor in the vast majority of cases will prescribe antibiotic therapy.

Medications

A few decades ago, the main antibiotics prescribed for Staphylococcus aureus were penicillin drugs. They cured purulent processes, stopped the development of septic complications. But Staphylococcus aureus eventually developed resistance to penicillins and "learned" to quickly destroy and neutralize the antibiotic.

Nevertheless, some penicillin preparations - mostly of the latest generation - are still used to suppress staphylococcal infections. Such drugs include, for example, Oxacillin, Amoxicillin and others. Antibiotics of the cephalosporin group are no less effective - for example, we are talking about Cefazolin, Cefuroxime.

With a more complex course of pathology is prescribed:

• Vancomycin is administered to newborn children at the rate of 15 mg/kg of weight per day, and infants from one month of age are administered 10 mg/kg of weight twice a day. During therapy, mandatory monitoring of the drug concentration in the blood serum is required. Intramuscular administration of vancomycin is very painful, so intravenous drip administration of the drug is preferable.
• Clindamycin is not recommended for use in children under six years of age, but may be prescribed for indications, if the doctor considers such prescription necessary. The dosage is calculated individually. Probable side effects are digestive disorders, immune disorders.
• Co-trimoxazone is used for the treatment of children from 3 months of age. The dosage for infants up to six months of age is determined at the rate of ¼ tablet twice a day. After six months, the child can be given half a tablet twice a day, at the same time. The duration of treatment - up to one week. Side effects: allergies, digestive disorders.
• Doxycycline and Minocycline are not recommended to be prescribed to young children, but may be adjusted at the discretion of the physician.

The doctor decides which medication to choose. He also makes adjustments to the standard therapeutic regimen, if necessary.

Immediately before starting treatment, it is recommended to take a test that determines the sensitivity of the bacterium to antibiotic therapy.

Enterofuryl for staphylococcus aureus in an infant

Enterofuril is an effective and relatively safe antibacterial drug, so it is actively used for Staphylococcus aureus in infants and older children. The drug has the necessary therapeutic effect due to the active component nifuroxidase - a bactericidal substance with a wide range of activity, which disrupts the production of the enzyme dehydrogenase and prevents the multiplication of bacteria.

Enterofuril acts strictly selectively, so the vast majority of beneficial microflora does not suffer. In addition, resistance to the drug is practically not developed, systemic action does not occur. [10]

The drug is indicated for the treatment of staphylococcal infection in children starting from one month of age. Enterofuril is usually well tolerated, and side effects are extremely rare and are manifested only by an allergic response to the administration of the drug.

Treatment of Staphylococcus aureus in infants with bacteriophage

Staphylococcal sepsis, enterocolitis in infants and newborns often requires administration of bacteriophage in the form of high enemas (by catheter or gas tube) two to three times a day in the amount of 5-10 ml. If vomiting and regurgitation are absent, bacteriophage can be administered orally, mixed with breast milk. Sometimes practiced combined treatment, alternating oral and enema administration of the drug. The average duration of the treatment course is from five to fifteen days.

If there are recurrences of infection, the course of bacteriophage is repeated.

If necessary to treat omphalitis, pustular skin lesions bacteriophage is applied applicatorily, every day in the morning and evening: gauze napkin is treated with bacteriophage and applied to the affected area.

Prevention

Preventive measures against Staphylococcus aureus are simple, they are few, but they are all very important to ensure the health of a young child. And they consist of the following:

• Maintaining the hygiene of both mom and baby;
• Supporting and strengthening the infant's immune defenses;
• limiting communication of strangers with a small child, avoiding visits to public places;
• Ensuring full and competent nutrition of the mother, establishing breastfeeding of the baby;
• Providing care for the infant, with hygiene not only of the hands but also of the mother's breasts, clothing, bedding, toys, utensils, and any objects in the house.

Staphylococcus aureus is considered a rather unfavorable microorganism, so in no case should you try to get rid of the bacterium on your own. At the first symptoms of infectious pathology, the help of a medical specialist must necessarily follow.

Forecast

Further prognosis depends on the complexity of the infectious lesion and on the timeliness and effectiveness of the prescribed therapy. Staphylococcus aureus in infants is particularly dangerous, as it can provoke septic complications, infectious toxic shock, coma and even death of the patient. With uncomplicated infection, the prognosis can be considered favorable, but generalized lesions - for example, with the development of sepsis - in about half of cases ends lethally.