Silver dressing in the management of an infant's urachal anomaly infected with methicillin-resistant Staphylococcus aureus: A case report

Abstract

BACKGROUND

Symptomatic urachal anomalies are rare disorders. The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life. However, recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management. In this case, we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well.

CASE SUMMARY

Female baby A, weighing 2.88 kg at 38⁺⁵ wk of gestational age, was referred to the hospital because of a red, swollen umbilicus approximately 2 cm × 2 cm in size with yellow purulent exudate. Through physical and ultrasound examination, the baby was finally diagnosed with a urachal anomaly. We first used oxacillin to prevent infection for 3 d. On the 4^th day, microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing. After 5 d, the symptoms of the umbilicus disappeared, and we discontinued silver dressing application. On the 12^th day, umbilical exudate testing was negative for MRSA. On the 14^th day, the baby's blood testing showed a white blood cell count of 14.7 × 10⁹/L, neutrophil percentage of 27.8%, and C-reactive protein level of 1.0 mg/L, suggesting that the infection had been controlled. We stopped treatment, and the baby was discharged with no complications. In this case, the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods, which was a different course from that of some other urachal remnant cases.

CONCLUSION

Anomalies that do not connect with the bladder can be treated with nonoperative management, including application of conservative antibiotics and local intervention with silver-based dressings. Silver sulfate dressings are absolutely safe for neonates with judicious use, and they play an established role in preventing infection without resistance, which is a common problem with other antibiotics and antiseptics.

Keywords: Urachal anomaly, Infection, Neonate, Infant, Silver dressing, Case report

Core Tip: Immediate surgical excision of urachal remnants has been generally recommended before. However, patients suffer multiple postoperative complications, resulting in re-operation. Recently, accumulating evidence has indicated that a nonoperative approach may be a safe, reasonable alternative to surgical intervention, especially in patients under 6 mo old. Here, we report a case of urachal anomaly with infection that managed with non-surgical therapy, including: Infection control, wound management and nutrition support. After 2 wk, umbilical symptoms fully recovered. Reoccurring symptoms were not found during follow-up.