社区相关耐甲氧西林金黄色葡萄球菌研究进展

以往由耐甲氧西林金黄色葡萄球菌(MRSA)所致感染多发生在医院环境,近年来社区相关MRSA的感染呈逐年上升趋势。社区相关MRSA与医院相关MRSA相比有着显著不同的特点:典型的社区相关MRSA菌株多携带SCCmecⅣ型基因;一般只对β-内酰胺类抗生素耐药;产生潘顿-瓦伦丁杀白细胞素(PVL);感染者多为既往身体健康的年轻人等。     

耐甲氧西林金黄色葡萄球菌肺炎11例诊治体会

耐甲氧西林金黄色葡萄球菌 (MRSA)为重症院内获得性肺炎和重症社区获得性肺炎的一个重要病原体 ,其对所有β-内酰胺类抗生素耐药。 MRSA肺炎的诊断和治疗均存在很多困难。为提高对本病的认识 ,现将我们收治的 11例 MRSA肺炎的诊治体会介绍如下。临床资料 :本组 11例中 ,男 7例、女 4例 ;≤ 14岁 2例 ,≥6 0岁 1例 ,15～ 5 9岁 8例。其基础疾病分别为急性脑血管病昏迷 3例 (均鼻饲流质 ,胃管测 p H值 ,且应用质子泵抑制剂 ,其中 1例气管内插管、机械辅助呼吸 ) ,有机磷中毒呼吸衰竭、气管内插管机械辅助呼吸 2例 ,糖尿病 1例 ,慢性阻塞…     

耐甲氧西林金黄色葡萄球菌是社区获得性肺炎的病原

美国IDSA上，研究人员提出，耐甲氧西林金黄色葡萄球菌(MRSA)可能将很快会在你附近的诊所中出现。     

耐甲氧西林金黄色葡萄球菌研究进展

耐甲氧西林金黄色葡萄球菌(methicillinresistant staphylococcus aureus，MRSA)为院内感染的重要病原菌，MRSA感染、乙型肝炎和获得性免疫缺陷综合征被列为世界范围内三大最难解决的感染性疾患，成为各国研究的热点。本就其流行病学、耐药机制治疗研究进展作一综述。     

呼吸道耐甲氧西林金黄色葡萄球菌耐药临床分析

目的了解呼吸道耐甲氧西林金黄色葡萄球菌(MRSA)感染现状及耐药性。方法选择2010-11～2011-10门诊及住院患者呼吸道标本培养的263株金黄色葡萄球菌进行分析。结果 MRSA分离率为57.79%(152/263),药敏显示MRSA对万古霉素及利奈唑胺敏感,对复方新诺明及利福平保持一定敏感性,对β-内酰胺类、喹诺酮类、大环内酯类、氨基糖苷类耐药率在80%以上。结论呼吸道MRSA多重耐药情况严重,应首选万古霉素或利奈唑胺。     

耐甲氧西林金黄色葡萄球菌的耐药状况及治疗进展

革兰阳性菌的耐药状况日趋严重和复杂,给临床治疗带来很大困难.研究革兰阳性菌的耐药机制、寻求对革兰阳性耐药菌有效的药物成为近年来国内外研究关注的热点.耐甲氧西林金黄色葡萄球菌是目前研究较为集中和深入的革兰阳性耐药致病菌之一,本文简要对其感染状况、耐药趋势、耐药机制及抗耐甲氧西林金黄色葡萄球菌感染药物研究等方面的进展作一综述.     

社区获得性耐甲氧西林金黄色葡萄球菌

社区获得性耐甲氧西林金黄色葡萄球菌是社区感染中重要的致病菌之一,以往由其所致感染多发生在医院环境,如今其引起的社区感染的比例不断上升.自1961年发现第1株耐甲氧西林金黄色葡萄球菌以来,耐甲氧西林金黄色葡萄球菌在世界各地流行并引起暴发流行,耐药程度不断加重.尤其1996年万古霉素不敏感金黄色葡萄球菌及2002年耐万古霉素金黄色葡萄球菌的出现,显示其对人类的威胁愈趋严重,已成为当今感染医学一个难题.本文介绍社区获得性耐甲氧西林金黄色葡萄球菌的流行情况及防治措施.     

耐甲氧西林金黄色葡萄球菌医院感染分析

耐甲氧西林金黄色葡萄球菌(MRSA)对多种抗生素耐药，全身感染者病死率高达50％，临床治疗颇为棘手。2002年1月至2003年6月，我院收治33例MRSA医院感染患者，现将其临床资料进行分析，并提出相应的对策。     

耐甲氧西林金黄色葡萄球菌院内肺部感染的临床研究

目的总结耐甲氧西林金黄色葡萄球菌(MRSA)院内肺部感染的特点及万古霉素的疗效.方法分析4年来确诊为MRSA院内肺部感染69例,研究其相关易感因素、药敏试验、抗生素使用情况和治疗效果.结果69例均存在严重基础疾患、人工气道、机械通气、抗生素的滥用和免疫功能低下等因素.MRSA对万古霉素100%敏感,三甲磺胺和利福平敏感率较高,其余抗生素敏感率极低.万古霉素治疗效果好.结论MRSA院内肺部感染者均存在明确易感因素.万古霉素为首选的治疗药物.     

社区获得性耐甲氧西林金黄色葡萄球菌肺炎临床分析

目的 探讨社区获得性耐甲氧西林金黄色葡萄球菌肺炎的临床特点.方法 对16例确诊病例的临床资料进行回顾性研究.结果 16例确诊病例,13例无基础性疾病,9例合并休克,7例合并急性呼吸窘迫综合征,4例死亡;死亡者从出现症状入院至死亡平均时间为(5.9±6.1)d,生存者平均住院时间为(21.6±11.1)d;8例有流感样症状,7例有咯血,5例有白细胞减少,16例C-反应蛋白明显升高,平均为(211.1±121.9) mg/L,13例有多肺叶病变,9例有胸腔积液.结论 社区获得性耐甲氧西林金黄色葡萄球菌肺炎病情凶险,应提高对其临床特点的认识,优化综合治疗方案.     

耐甲氧西林金黄色葡萄球菌杀白细胞素基因亚型的流行及MLST分子分型

目的 探讨临床分离的耐甲氧西林金黄色葡萄球菌(MRSA)杀白细胞素(pvl)基因亚型的流行及MLST分子分型特征.方法 收集非重复MRSA 287株,按照美国疾病预防控制中心的社区获得性耐甲氧西林金黄色葡萄球菌(CA-MR-SA)定义分为医院获得性耐甲氧西林金黄色葡萄球菌(HA-MRSA)和CA-MRSA两组.采用PC...     

社区相关性甲氧西林耐药金黄色葡萄球菌:一个值得关注的病原体

社区相关性MRSA近年来逐渐为人们所重视,作为引起医院外感染的重要病原体之一,近年的研究表明其发病率呈不断上升的趋势,与传统的导致院内感染的MRSA相比,社区相关性MRSA有其独特的流行病学特点、发病机制和耐药机制。制定合理的治疗和预防措施显得格外重要。     

Implantable cardioverter defibrillator lead-related methicillin resistant Staphylococcus aureus endocarditis: Importance of heightened awareness

Methicillin resistant Staphylococcus aureus(MRSA) septicemia is associated with high morbidity and mortality especially in patients with immunosuppression,diabetes,renal disease and endocarditis.There has been an increase in implantation of cardiac implantable electronic devices(CIED) with more cases of devicelead associated endocarditis been seen.A high index of suspicion is required to ensure patient outcomes are optimized.The excimer laser has been very efficient in helping to ensure successful lead extractions in patients with CIED infections.We present an unusual case report and literature review of MRSA septicemia from device-lead endocarditis and the importance of early recognition and prompt treatment.     

Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae

Background

The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options.

主动外排系统在耐甲氧西林金黄色葡萄球菌多重耐药中的作用

目的分析耐甲氧西林金黄色葡萄球菌（MRSA）主动外排基因（qacB、qacJ、smr），探讨其在MRSA多重耐药中的作用。方法采用计算机引物设计软件（Primer Premier 5．0）设计外排泵基因（qacB、qacJ、smr）引物，用PCR和电泳分析方法检测124株MRSA主动外排基因；用利血平进行MRSA协同抑制试验，观察其对利福平和左旋氧氟沙星药敏性的变化。结果124株MRSA中检出外排泵qacB基因86株，检出率为69．4％；qacJ基因45株，检出率为36．3％；smr基因32株，检出率为25．8％。利血平抑制实验结果显示MRSA对左旋氧氟沙星和利福平的最低抑菌浓度值下降2～32倍，表明其耐药性降低。结论MESA存在qacB、qacJ、smr等多种主动外排系统，在其多重耐药中起重要作用。     

Health care-associated Staphylococcus aureus pneumonia

INTRODUCTION: While Staphylococcus aureus is an uncommon but serious cause of traditional community-acquired pneumonia (CAP), it is a predominant cause of nosocomial pneumonia in addition to the unique clinical entity of health care-associated pneumonia (HCAP). A cohort of bacteremic S aureus pneumonia cases was reviewed to determine the role of HCAP among the cohort, and to assess for differences between CAP and HCAP. PATIENTS AND METHODS: Bacteremic S aureus pneumonia cases were identified from a prospective study of all patients diagnosed with CAP who presented to hospitals in Edmonton, Alberta, between November 2000 and November 2002. These cases were subsequently reviewed retrospectively. Demographic, clinical and microbiological data were obtained, and patients were classified as having CAP or HCAP. Relatedness of isolates was determined by pulsed-field gel electrophoresis analysis in conjunction with epidemiological information. RESULTS: There were 28 cases of bacteremic S aureus pneumonia identified. Fifty-seven per cent were reclassified as having HCAP, and 43% remained classified as having CAP. The CAP cohort was significantly younger than the HCAP cohort (mean age 49.0+/-23.7 years versus 67.8+/-18.6 years; P=0.035) with higher rates of intravenous drug use (50% versus 0%; P=0.002). Long-term care facility residence (44%) was common in the HCAP cohort. The HCAP cohort presented with more severe illness, having a higher mean pneumonia severity index score (143.1+/-41.1 versus 98.2+/-54.6; P=0.028), and despite fewer embolic complications, there was a trend toward a significantly higher mortality rate (31% versus 0%; P=0.052). Two community-acquired isolates cultured in the setting of intravenous drug use were methicillin-resistant, and no isolates were positive for Panton-Valentine leukocidin. There was evidence of relatedness involving 44% of the HCAP isolates by pulsed-field gel electrophoresis analysis. CONCLUSION: HCAP accounts for a significant number of cases that, when using traditional definitions, would be classified as CAP. Severity of illness and mortality was excessive within the HCAP group. There was evidence of relatedness and spread of common strains in the HCAP cohort. The present study supports recommendations for treatment guidelines directed toward the entity of HCAP and the empirical coverage of S aureus among certain high-risk groups.     

The impact of incident methicillin resistant Staphylococcus aureus detection on pulmonary function in cystic fibrosis

The incidence of methicillin resistant Staphylococcus aureus (MRSA) infection is increasing in cystic fibrosis (CF), but the impact of MRSA detection on clinical outcomes is unclear. Our objective was to determine whether incident detection of MRSA is associated with a change in pulmonary function over time in CF patients. We analyzed data from the Epidemiologic Study of Cystic Fibrosis (ESCF), a prospective observational study of CF patients in North America. Multivariable piecewise linear regression was used to model the impact of incident detection of MRSA on pulmonary function over time, measured by percent predicted forced expiratory volume in one second (FEV(1)% predicted), adjusting for potential confounders. There were 5,090 patients >or=6 years old who were MRSA negative for at least 2 calendar years. Five hundred ninety-three (12%) of these patients acquired MRSA during the years 2001-2003, with detection rates of MRSA during those years rising from 4.4% to 6.9%. MRSA positive patients had a lower FEV(1)% predicted and received more antibiotic and other therapies than patients who remained MRSA negative. After adjusting for antibiotic therapy and other potential confounders, MRSA positive patients also had a higher rate of decline in FEV(1)% predicted both before and after the incident culture, although the rate of FEV(1)% predicted decline did not change significantly after MRSA detection. In conclusion, although MRSA in CF was a marker for more aggressive therapy and may reflect increased disease severity, incident MRSA detection was not associated with a changing rate of FEV(1)% predicted decline.     

甲氧西林耐药金黄色葡萄球菌对氨基糖苷抗生素耐药机制的研究

为研究甲氧要耐药金黄色球菌（ＭＲＳＡ）对氨基糖苷类抗生素的耐药机制，应用氨基醭 抗生素耐药谱推测法、核素标记分析法、Ｓｏｕｔｈｅｍ印迹和斑点杂交试验对１００株ＭＲＳＡ进行了耐药研究。结果：根据细菌对氨基糖苷抗生素的耐药谱，１００株ＭＲＳＡ可以分成４类，６５株细菌产生ＡＡＣ（６）－ＡＰＨ（２）钝化酶，２４株产生ＡＡＣ（６）－ＡＰＨ（２）＋ＡＰＨ（３），１０株产生ＡＡＣ（６），还有１株产生ＡＡＣ（６）