耐甲氧西林金葡菌的研究进展

耐甲氧西林金葡菌已成为医院及社区感染的主要病原菌之一.经重组获得的mec复合体是其产生耐药性的结构基础,并通过产生PBP2a表达抗药性,而金葡菌耐药性表达及表达程度还受其内在的固有基因影响.本文就其流行病学、耐药机制及检测方法研究进展作一综述.     

650株耐甲氧西林金葡菌的感染现状及耐药性分析

目的:分析江苏大学附属医院临床耐甲氧西林金黄色葡萄球菌(MRSA)的分布特点及耐药情况。方法:采用回顾性统计与分析方法,对2009年—2011年3年间临床送检的医院住院患者的各类标本中分离出的MRSA的病原菌,对其感染现状及耐药性进行分析。结果:3年间各类送检标本中分离出金黄色葡萄球菌984株,经筛选,其中MRSA为650株,占66.06%;痰与分泌物的标本中分离率为最高,占95.38%(620/650);MRSA的检出率呈上升趋势,并对大多数抗菌药物产生不同程度的耐药,尚未发现对万古霉素、替考拉宁、利奈唑胺的耐药菌株。结论:MRSA的检出率及耐药率逐年升高,且多重耐药性现象严重;应加强行政干预,采取多渠道、多部门联合的综合防控措施以遏制MRSA耐药率的增长。     

耐甲氧西林金葡菌到万古霉素高度耐药金葡菌的发展及其感染的药物治疗

随着万古霉素用量增加,耐甲氧西林金葡菌(MRSA)对万古霉素敏感性逐渐下降.依据其对万古霉素敏感性的差异可分成异质性万古霉素中度耐药金葡菌(hVISA)、万古霉素中度耐药金葡菌(VISA)和万古霉素高度耐药金葡菌(VRSA)等3类.本文简要综述卜述3类金葡菌的发展、相关耐药机制及其感染的药物治疗现状.     

治疗耐甲氧西林金葡菌感染的药物选择

近年来，耐甲氧西林金葡菌(MRSA)感染的病例呈上升趋势，分布特点是：经济发达地区高于经济落后地区，城市高于农村；医院内感染高于医院外感染，危重病房高于普通病房；院内感染多见于老年体弱重病者，社区多见于小儿。MRSA显著特点是，耐药广泛、易感性强。目前已成为临床的难题之     

耐甲氧西林金葡菌的耐药分子机制研究

自1961年发现第一株耐甲氧西林金葡菌(MRSA)至今,其耐药问题已严重影响临床抗感染治疗的疗效,引起广泛重视。近年来,随着分子生物技术的不断发展,人们对其耐药机制的研究逐步深入。对MRSA耐药机制的研究进展,特别是耐β-内酰胺类抗生素的分子机制,包括其耐药决定性基因mecA基因,以及fem基因等其他辅助基因进行重点介绍。     

耐甲氧西林金葡菌

金葡菌是许多人类致病原中的一种,20世纪30年代后期由于磺胺药物的应用而有效地控制了金葡菌感染,但因感染部位的脓液及细菌耐药性的形成,使得这类药物对金葡菌的作用大为降低。20世纪40年代初青霉素G的应用,暂时解决了葡萄球菌感染问题,由于青霉素的连续应用而出现了耐药菌株,产生了青霉素酶。1948年耐药菌株大流行,已严重地削弱了青霉素的治疗价值;20世纪50年代末,金葡菌对包括红霉素、链霉素和四环素类在内的几乎所有全身性应用抗生素都产生了耐药性,因此,应用抗生素已无法控制医     

万古霉素治疗耐甲氧西林金葡菌性肺炎三例报告

目的探讨3例患者应用万古霉素治疗耐甲氧西林金葡菌(MRSA)性肺炎的疗效。方法对3例应用万古霉素治疗MRSA性肺炎患者治疗前后的临床症状、不良反应进行分析。结果万古霉素治疗MRSA性肺炎有较高的疗效,对MRSA敏感且不易产生耐药,但是存在胃肠道不良反应以及肝损害、肾毒性。结论合理的应用万古霉素治疗MRSA性肺炎疗效强,但在高龄老年患者中使用万古霉素应该谨慎。     

耐甲氧西林金葡球菌的药物防治

耐甲氧西林的金葡球菌(MRSA)已成为医院内感染的主要致病菌之一,其检出率呈逐年上升的趋势.MRSA不仅对β-内酰胺类抗菌药耐药,而且对大多数大环内酯类、四环素类、林可霉素等耐药.MRSA的传染源主要为MRSA感染者及携带者、医疗器具或物品等;传播途径(方式)为患者-医务人员-患者,也可通过空气或接触传播;接受免疫抑制剂、免疫缺陷、放疗、化疗、年老体弱及手术患者、烧伤患者等是MRSA的重要易感者,感染金葡球菌的烧伤者70%~92%为MRSA感染.     

耐甲氧西林金葡球菌的研究进展

耐甲氧西林金葡球菌(MRSA)在医院和社区获得性感染中具有重要地位,作为出现最频繁的感染性病原菌具有极好的对各种抗菌药物的适应性,并引起耐药.笔者就MRSA的流行病学特征调查和耐药机制研究的进展进行综述,为临床合理用药及新药研发提供参考.     

Registered and investigational drugs for the treatment of methicillin-resistant Staphylococcus aureus infection

First isolated in the 1960s methicillin-resistant Staphylococcus aureus (MRSA) has become a leading hospital acquired (HA) pathogen, although community acquired isolates (CA-MRSA) are on the rise, particularly in the USA. Treatment of serious MRSA infections has been based for many years upon the use of glycopeptides, i.e. vancomycin and teicoplanin. Other drugs indicated in particular clinical settings, such as prosthetic valve endocarditis or osteomyelitis, are rifampin, gentamycin, fusidic acid, minocycline, co-trimoxazole, clindamycin. Quinolones and doxycycline may be active on some MRSA isolates, and add some this important clinical setting. In the last few years new anti-MRSA drugs have been registered and patented, expanding therapeutic opportunities, i.e. linezolid, the first oxazolidinone, available both as oral and parenteral formulation in being the most widely used new anti-MRSA agent, quinupristin-dalfopristin, daptomycin, a novel lipopeptide, active on germs both in the replicating and in the resting phase, and tigecycline, the first approved glycylcycline. Other drugs from different classes are in the pipeline and will further enhance in the next few years our therapeutic armamentarium: three glycopeptides, i.e. dalbavancin, telavancin, and oritavancin, two broad spectrum cephalosporins, ceftobiprole and ceftaroline, iclaprim, a diaminopyrimidine, as well as a carbapenem, CS-023/RO-4908463, and adjuvant therapies such as the monoclonal antibody tefibazumab.     

Multiple-delayed release formulation approach for the treatment of methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequent nosocomial pathogens in developed countries. Although several novel antibacterial agents possessing novel mode of action have been developed to date, the continuous effort to investigate an effective combination of front-line drugs is considered important in anti-MRSA drug development. The combination chemotherapy with front-line drugs is expected to provide effective, safe, and less expensive treatment. Oral trimethoprim/sulfamethoxazole combination therapy has been utilized for treatment of several nosocomical infections. Importantly, no antagonism has been reported for combinations of trimethoprim with many other front-line antibiotics. MiddleBrook Pharmaceuticals has developed the pulsatile delivery systems of three to four different antibacterial agents, including trimethoprim and sulfamethoxazole, for the treatment of MRSA infections. The liberation of individual drugs theoretically follows a programmable lag phase (no release) from the time of administration. Pulsatile drug delivery system provides optimal release profiles for a combination of drugs. The clinical data that would be obtained based on these claims are expected to be of significance in terms of developing combination chemotherapy for MRSA infections via a pulsatile drug release control system.     

万古霉素治疗耐甲氧西林金黄色葡萄球菌的疗效和血药浓度分析

目的：探讨万古霉素治疗耐甲氧西林金黄色葡萄球菌感染的临床疗效、血药谷浓度、不良反应三者的关系。方法：调查本院2008年1月-2009年10月住院部确诊为耐甲氧西林金黄色葡萄球菌感染并使用万古霉素治疗者82例,观察其临床疗效、细菌学疗效及不良反应,并测定其血药谷浓度。结果：万古霉素血药谷浓度小于5μg/mL、5～10μg/mL及大于10μg/mL的治疗有效率分别为68.75%、72.73%和81.82%;细菌清除率分别为62.50%、68.18%和72.73%,1例血药谷浓度为14.6μg/mL的患者出现肾毒性。结论：增加万古霉素血药谷浓度可提高治疗耐甲氧西林金黄色葡萄球菌感染的疗效和细菌清除率,但出现肾毒性不良反应几率也相应增大。     

Successful treatment of methicillin-resistant Staphylococcus aureus endocarditis with linezolid

We report the successful treatment with linezolid of a methicillin-resistant Staphylococcus aureus (MRSA) endocarditis in a patient with a severe allergic reaction to glycopeptides. Linezolid is a drug with well-recognised activity against S. aureus and proved to be efficacious even in the unusual site of heart valves. This drug could be a good therapeutic choice when glycopeptides treatment is not feasible.     

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。     

Imported methicillin-resistant Staphylococcus aureus infection: a case report.

The first isolate of a methicillin-resistant strain of Staphylococcus aureus at the Wellington Hospital was made on 31 March 1976, from a man who had emigrated from the United Kingdom in 1973. The infection was successfully treated with co-trimoxazole and fucidin. The epidemiological implications of this infection are discussed.     

Community-acquired methicillin-resistant Staphylococcus aureus infections

Methicillin-resistant Staphylococcus aureus (MRSA) should no longer be regarded as a strictly nosocomial pathogen. During the past decade, community-acquired MRSA (CA-MRSA) infections among young persons without healthcare-associated (HCA) risk factors have emerged in several areas worldwide. These infections are caused by strains that almost exclusively carry the staphylococcal cassette chromosome mec type IV element and the Panton-Valentine leukocidin genes and, unlike HCA-MRSA strains, are not multiresistant. Although the majority of CA-MRSA infections are mild skin and soft tissue infections, severe life-threatening cases of necrotizing pneumonia, necrotizing fasciitis, myonecrosis and sepsis have been reported. Clindamycin is an effective agent for skin and soft tissue infections, however attention should be paid to the possibility of the emergence of resistance during treatment in strains with the macrolide, lincosamide and group B streptogramin (MLS(B))-inducible resistance phenotype. For patients with invasive infections that may be caused be CA-MRSA, vancomycin, teicoplanin and linezolid represent appropriate empirical therapeutic options.     

耐甲氧西林金黄色葡萄球菌的研究进展

耐甲氧西林金黄色葡萄球菌(MRSA)已成为医院感染重要的致病菌,MR-SA引起的感染,因其耐药高、死亡率高及经济负担重,成为威胁全球公共卫生安全的严重问题.MRSA多重耐药现象日益严重.了解MRSA的现状,才能更好地及时治疗并且尽可能避免MRSA感染,因此本文对MRSA的流行现状、临床感染、治疗药物、预防传播及经济负担等最新研究现状进行概述.     

Beta-lactams against methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) have developed resistance to virtually all non-experimental antibiotics. They are intrinsically resistant to beta-lactams by virtue of newly acquired low-affinity penicillin-binding protein 2A (PBP2A). Because PBP2A can build the wall when other PBPs are blocked by beta-lactams, designing beta-lactams capable of blocking this additional target should help solve the issue. Older molecules including penicillin G, amoxicillin and ampicillin had relatively good PBP2A affinities, and successfully treated experimental endocarditis caused by MRSA, provided that the bacterial penicillinase could be inhibited. Newer anti-PBP2A beta-lactams with over 10-fold greater PBP2A affinities and low minimal inhibitory concentrations were developed, primarily in the cephem and carbapenem classes. They are also very resistant to penicillinase. Most have demonstrated anti-MRSA activity in animal models of infection, and two--the carbapenem CS-023 and the cephalosporin ceftopibrole medocaril--have proceeded to Phase II and Phase III clinical evaluation. Thus, clinically useful anti-MRSA beta-lactams are imminent.