耐甲氧西林金黄色葡萄球菌感染的研究进展

凡对甲氧西林、苯唑西林耐药或Mec基因阳性的金黄色葡萄球菌定义为耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus MRSA),由于其致病力强,传播速度快,常出现多重耐药性,在院内播散可导致病区内的暴发流行,其耐药机制非常复杂,治疗难度大,病死率高,已成为医院感染中的严重问题。笔者就MRSA的感染现状、耐药机制及治疗进展综述如下。     

甲氧西林耐药金黄色葡萄球菌耐药性研究及检测

甲氧西林耐药的金黄色葡萄球菌(MRSA)对多种抗生素耐药,包括临床常用抗生素,和近年来新上市的抗生素,由MRSA引起的感染已成为抗感染治疗最主要的威胁之一.面对这种情况,了解MRSA对多种抗生素的耐药机制,阐述社区和医院内感染MRSA的分子流行病学特征,介绍先进的MRSA的检测方法,是很有必要的.     

157株MRSA菌株的耐药调查及感染病例的用药分析

目的:分析我院耐甲氧西林金黄色葡萄球菌(MRSA)的耐药现状及抗感染用药现状。方法:对157株MRSA菌株进行耐药率统计,对感染病例进行用药全程的回顾性分析。结果:万古霉素类仍为目前对MRSA最敏感(耐药率为0)和使用最多的品种,其他抗生素耐药情况严重。菌株确认及药敏试验报告滞后,导致治疗前期的敏感品种选择率偏低。结论:MRSA的耐药现状日趋严重,及时进行MRSA的分离确认和药敏试验,有利于提高合理使用抗菌药水平。     

绿茶对耐甲氧西林金黄色葡萄球菌的抗菌作用及机制研究进展

泛耐药的出现,使得耐甲氧西林金黄色葡萄球菌(MRSA)感染的治疗成为临床棘手的问题。绿茶提取物对MRSA有一定的抗菌作用。本文就绿茶对MRSA感染的临床试验、与抗生素的协同抗MRSA作用、有效成分的分离分析及作用机制作一综述。     

抗耐甲氧西林金黄色葡萄球菌感染治疗的研究进展

耐甲氧西林金黄包葡萄球菌(MRSA)是医院感染常见的致病菌,近年来医院的检出率逐渐升高,耐药程度日趋加重,已成为当今感染医学的一个亟待解决的难题。随着抗菌药物的不断开发利用,新思路及新技术在感染医学当中的应用,将开辟治疗MRSA感染的新途径。本文从不同角度介绍MRSA抗菌药物的研发、免疫治疗及RNA干扰技术在抗MRSA感染治疗中的进展。     

MRSA感染33例临床分析

甲氧西林耐药的金黄色葡萄球菌(methici llinresistant staphylococcus aureus,MRSA)是引起医院获得性感染的主要病因,在第一个耐青霉素霉的β内酰胺酶类抗生素甲氧西林用于临床不久,便在英国发现了世界上首例MRSA[1].目前,MRSA已成为医院获得性感染的常见致病菌之一,且常为多重耐药菌[2],治疗较为困难.本文对我院重症医学科(ICU)检出的33株MRSA进行临床分析,旨在为ICU患者MRSA感染的防治提供参考依据.     

住院患者耐甲氧西林金黄色葡萄球菌感染108例分析

目的 了解我院耐甲氧西林金黄色葡萄球菌(MRSA)的感染现状,指导临床合理选用抗生素,预 防院内交叉感染,为临床防治提供依据.方法 对108例感染MRSA的住院患者进行观察和随访,对所得结果进行统计分析,总结MRSA的耐药结果并查找MRSA感染的危险因素.结果 MRSA对β-内酰胺酶类皆耐药;对其他药物的敏感性相对...     

杀白细胞毒素基因阳性耐甲氧西林金黄色葡萄球菌的四环素耐药基因的检测

随着抗生素的大量广泛应用,近年来耐甲氧西林金黄色葡萄球菌(MRSA)已经成为医院感染中常见的病原菌,MRSA具有多重耐药特征,常表现为对β-内酰胺类、四环素类等多种抗生素同时耐药,给临床治疗带来困难。为进一步探讨MRSA对四环素类抗菌药物的耐药机制与MRSA的致     

医院感染耐甲氧西林金黄色葡萄球菌的耐药性分析

为了解医院感染耐甲氧西林金黄色葡萄球菌(MRSA)的耐药情况,对从住院病人各种临床标本中分离出的金黄色葡萄球菌(sau)进行药敏试验(测MIC),用苯唑青霉素(OX)代替甲氧西林测MRSA.结果共分离出93株MRSA,其中73株属医院感染,其对青霉素类、头孢菌类素及亚胺硫霉素等的耐药率为100%;对庆大霉素、红霉素、四环素、环丙氟哌酸、氯霉素、克林霉素耐药率达50.0%以上;对复方新诺明、利福平耐药率为47.9%、38 .4%;对万古霉素耐药率为0.0%.结论:MRSA对临床常用的抗生素存在高度耐药性,万古霉素是治疗医院感染MRSA的首选药物.     

医院感染耐甲氧西林金黄色葡萄球菌的耐药性分析

为了解医院感染耐甲氧西林金黄色葡萄球菌(MRSA)的耐药情况,对从住院病人各种临床标本中分离出的金黄色葡萄球菌(sau)进行药敏试验(测MIC),用苯唑青霉素(OX)代替甲氧西林测MRSA.结果共分离出93株MRSA,其中73株属医院感染,其对青霉素类、头孢菌类素及亚胺硫霉素等的耐药率为100%;对庆大霉素、红霉素、四环素、环丙氟哌酸、氯霉素、克林霉素耐药率达50.0%以上;对复方新诺明、利福平耐药率为47.9%、38 .4%;对万古霉素耐药率为0.0%.结论:MRSA对临床常用的抗生素存在高度耐药性,万古霉素是治疗医院感染MRSA的首选药物.     

社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)感染特点及治疗对策的研究进展

CA-MRSA指从门诊患者或是从住院48 h内的患者中分离出来的MRSA菌株,CA-MRSA与HA-MRSA感染的危险因素、患者群和感染特点均有较大的区别。本文综述了有关CA-MRSA引起感染性疾病的流行病学、基因分型鉴定方法、感染特点、对抗菌药物耐药性及治疗对策等研究进展。     

耐甲氧西林金黄色葡萄球菌医院感染防控效果与耐药性分析

目的:了解综合干预措施对耐甲氧西林金黄色葡萄球菌(MRSA)医院感染预防与控制的效果。方法:采取回顾性与前瞻性调查方法分别对未干预组和干预组MRSA医院感染病例的预防和控制效果进行调查分析。结果:MRSA医院感染总发生率为0.15%,病死率为9.40%。感染部位以下呼吸道感染为主(87.71%),手术伤口感染居第2位(5.93%)。MRSA对11种抗菌药物的耐药率大于80%。MRSA医院感染发生率和病死率(0.24%、11.11%)在综合干预后明显下降(0.11%、7.69%)。手术伤口感染率在干预后下降明显,由8.40%降至3.24%。不同临床科室中,神经内科和综合ICU取得较为显著的控制效果,感染所占比例分别由干预前的21.85%、14.29%降至干预后的8.55%、7.69%。结论:综合干预措施能有效预防和控制MRSA医院感染。     

Burden of methicillin-resistant Staphylococcus aureus: focus on clinical and economic outcomes

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a major public concern. Hospital-acquired MRSA rates have steadily increased over the past 25 years, and the bacterial strain is making inroads to the community. The morbidity and mortality burden of MRSA infection is compounded by delayed or inappropriate antibiotic treatment, taking a toll on health care resources that are already stretched thin. Vancomycin has historically been the drug of choice for this pathogen because its broad spectrum can address the multidrug resistance of most MRSA infections. Despite its sustained in vitro microbiologic inhibitory activity, researchers are beginning to question the continued utility of vancomycin for MRSA infections. Evidence against vancomycin is most notable with regard to nosocomial pneumonia and skin and soft tissue infections. In addition, because vancomycin must be administered intravenously, patients typically require prolonged hospitalization, which further increases the cost of MRSA treatment and exposes patients to additional nosocomial infections. Recent studies have shown that antibiotics with good bioavailability, such as linezolid, can be given orally to facilitate early hospital discharge, thus alleviating the economic burden of MRSA infections. Several agents have been developed over the past decade that have excellent in vitro activity against MRSA. Further studies are needed to determine if these drugs can better eradicate MRSA than vancomycin and remedy the adverse outcomes frequently observed with this organism.     

耐甲氧西林金黄色葡萄球菌感染对糖尿病足患者预后的影响

目的探讨耐甲氧西林金黄色葡萄球菌(MRSA)感染对糖尿病足患者预后的影响。方法选取我院2013年2月~2015年2月收治的金黄色葡萄球菌阳性糖尿病足患者92例,根据耐药试验分为MRSA组(45例,病原菌为MRSA)和MSSA组(47例,病原菌为甲氧西林敏感金黄色葡萄球菌)。比较2组一般资料、血生化指标、治疗方案及预后。结果 1比较MSSA组、MRSA组溃疡病程较长,溃疡面积较大,Wagner分级和感染严重程度分度均较重(P<0.05);2比较MSSA组、MRSA组WBC与hs-CRP水平较高,ALB水平较低(P<0.05);3MRSA组手术治疗人数较MSSA组多,2组除5例患者(MRSA组3例,MSSA组2例)因病情严重拒绝继续治疗,其余患者均痊愈或好转后出院。结论 MRSA感染糖尿病足患者溃疡病程长、溃疡面积较大,全身炎症反应较重,及时进行正确的细菌培养及药敏检测,展开积极对症治疗,可取得良好预后。     

Meticillin-resistant Staphylococcus aureus (MRSA): screening and decolonisation

Meticillin-resistant Staphylococcus aureus (MRSA) infections are of increasing importance to clinicians, public health agencies and governments. Prevention and control strategies must address sources in healthcare settings, the community and livestock. This document presents the conclusions of a European Consensus Conference on the role of screening and decolonisation in the control of MRSA infection. The conference was held in Rome on 5-6 March 2010 and was organised jointly by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC). In an environment where MRSA is endemic, universal or targeted screening of patients to detect colonisation was considered to be an essential pillar of any MRSA control programme, along with the option of decolonising carriers dependent on relative risk of infection, either to self or others, in a specific setting. Staff screening may be useful but is problematic as it needs to distinguish between transient carriage and longer-term colonisation. The consequences of identification of MRSA-positive staff may have important effects on morale and the ability to maintain staffing levels. The role of environmental contamination in MRSA infection is unclear, but screening may be helpful as an audit of hygiene procedures. In all situations, screening procedures and decolonisation carry a significant cost burden, the clinical value of which requires careful evaluation. European initiatives designed to provide further information on the cost/benefit value of particular strategies in the control of infection, including those involving MRSA, are in progress.     

溶葡萄球菌酶对控制烧伤创面MRSA感染的临床观察

目的探讨应用复合溶葡萄球菌酶治疗烧伤创面MRSA感染的效果。方法对67例烧伤创面MRSA感染患者的治疗进行回顾分析。结果67例患者应用复合溶葡萄球菌酶处理后创面感染均得到有效控制。结论外用复合溶葡萄球菌酶对控制烧伤创面MRSA感染效果显著。     

The role of screening and antibiotic prophylaxis in the prevention of percutaneous gastrostomy site infection caused by methicillin-resistant Staphylococcus aureus

BACKGROUND: Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy (PEG), especially in hospitals where methicillin-resistant Staphylococcus aureus (MRSA) is endemic. Evidence suggests that antibiotic prophylaxis at PEG insertion may reduce infection rates. AIM: To examine rates of peristomal MRSA infection before and after introduction of a screening, decontamination and antibiotic prophylaxis protocol. METHODS: Retrospective case analysis detected new peristomal MRSA infections over a 33-month period. Prospectively from October 2004, patients requiring PEG were screened and, if MRSA positive, received decontamination (5 days) and prophylactic teicoplanin before insertion. Peristomal wound sites were monitored after insertion. RESULTS: Peristomal MRSA infection was identified in 5/42 patients (12%) in 2002, 7/35 (20%) in 2003 and 7/24 (29%) in 2004 -- overall infection rate 19%. Of 47 patients undergoing new PEG insertions between October 2004 and August 2006 (four known MRSA and 10 identified by screening), one (2%) developed peristomal MRSA infection 14 days postprocedure. A significant reduction in MRSA peristomal infection has been demonstrated (P < 0.01). CONCLUSIONS: Screening for MRSA before PEG insertion identifies MRSA colonization and subsequent decontamination and antibiotic prophylaxis reduces peristomal MRSA infection rates. Where MRSA is endemic, the risk of wound site infection may remain postprocedure unless high standards of wound care are maintained.     

泌尿系统金黄色葡萄球菌感染125例分析

目的：探讨泌尿系统金黄色葡萄球菌感染的现状，耐药性及其治疗，方法：对125株感染泌尿系的金黄色葡萄球菌进行回顾性分析。结果：本组中耐甲氧西林金黄色葡萄球菌（MBSA）89株（71.2%)。甲氧西林敏感金黄色葡萄球菌（MSSA）36株（28.8%)。医院内感染77株（61.6%)。71株为MRSA（92.2%)。MRSA对青霉素类耐药率很高，对头孢类，氨基糖甙类和新型喹诺酮类抗生素均有程度不同的耐药，而对万古霉素100%敏感。结论：金黄色葡萄球菌是泌尿系感染重要的致病菌，其中MRSA占很大比重，MRSA的治疗应在药敏试验指导下用药，对于全身重度感染，万古霉素为首选。     

万古霉素与替考拉宁治疗肝移植术后MRSA菌血症疗效与安全性比较

目的：比较万古霉素和替考拉宁治疗重症监护病房肝移植术后耐甲氧西林金黄色葡萄球（MRSA）感染的疗效和安全性。方法：将12例肝移植术后MRSA感染病人随机分为万古霉素治疗组和替考拉宁治疗组,比较两组病人应用抗生素后的治愈率和不良反应。结果：万古霉素与替考拉宁治疗MRSA的治愈率分别为71．4％和60．0％,细菌清除率分别为88．2％和86．7％,不良反应发生率为28．5％和60％,两组间MRSA治愈率有显著性差异（P〈0．05）。结论：万古霉素对重症监护病房肝移植术后MRSA感染的早期治疗效果优于替考拉宁,可以作为此类病人的首选用药。     

环丙沙星和去甲基万古霉素治疗耐甲氧西林金葡菌心内膜炎的实验研究

耐甲氧西林金葡菌(MRSA)是院外和院内感染的重要致病菌,近年来已引起国内外许多学者的关注。环丙沙星为一新型氟代喹喏酮衍生物,体外实验证实,该品对MRSA有抗菌活性。本文旨在运用MRSA细菌性心内膜炎动物模型,对国产环丙沙星和去甲基万古霉素进行体内比较性研究,对环丙沙星的药物疗效进行临床前评价,为今后该品用于临床提供理论和实验依据。研究结果表明,经药物治疗三天后,赘生物菌落数明显下降,与实验对照组有显著差别(P<0.01),而治疗组间无差别(P>0.05)。可以预测,环丙沙星可能成为替代去甲基万古霉素治疗MRSA感染的较好品种之一,有待于在治疗人体感染中证实。