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.     

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。     

外用百多邦控制烧伤创面MRSA感染的临床观察

目的测定外用百多邦控制烧伤创面MRSA感染的临床效果。方法通过外用百多邦(治疗组)及SD-Ag冷霜(对照组)对比观察烧伤创面MRSA感染的治疗效果。结果外用百多邦较SD-Ag冷霜能有效地控制烧伤创面MRSA的感染。结论百多邦具有较强的杀灭MRSA的作用,能有效地控制烧伤创面MRSA的感染。     

美国耐甲氧西林金黄色葡萄球菌感染治疗临床治疗指南(一)

美国感染病学会(IDSA)制订了治疗耐甲氧西林金黄色葡萄球菌(MRSA)患者的循证指南。该指南用于指导MRSA感染患者的治疗。该指南就多种与MRSA疾病相关的临床症状的治疗进行了论述,包括:皮肤和软组织感染(SSTI)、菌血症和感染性心内膜炎、肺炎、骨和关节感染、中枢神经系统(CNS)感染等。该指南重点介绍了关于万古霉素用量及监测,以及对万古霉素低敏的耐甲氧西林金黄色葡萄球菌菌株感染的治疗方案及治疗失败的处置。     

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。     

对耐甲氧西林金黄色葡萄球菌感染患者的防控与护理

目的：通过对1例耐甲氧西林金黄色葡萄球菌（MRSA）感染病例的分析,增强对MRSA医院获得性感染的认识,以有效控制其传播。方法：取患者痰液、血液、尿液做细菌MRSA培养加药敏试验,确定诊断,合理治疗,规范管理。结果：患者,男,65岁,因急性硬膜下血肿入院,病程中出现MRSA败血症,继之出现双侧肺炎,因采取合理治疗和控制措施病情治愈,未发生MRSA交叉感染及爆发流行。结论：该患者为医院获得性MRSA感染,加强护理措施的落实能有效控制交叉感染及爆发流行。     

耐甲氧西林金黄色葡萄球菌肺炎24例临床分析

<正>随着医疗技术水平的不断提高、免疫抑制剂的使用、肿瘤及危重患者的增加,不仅使金黄色葡萄球菌医院感染的患者随之增加,耐甲氧西林金黄色葡萄球菌(MRSA)感染也逐渐增多,虽有社区获得性MRSA报道,但仍以医院获得性感染为主,已受到全球的广泛关注。为探讨MRSA医院获得性感染的严重程度与宿主机能状态关系、治疗及预后的关系,我们对我院呼吸科从2008年6月至2009年6月收治的24例MRSA肺部感染重症患者,随机分成2组使用药物敏感的抗生素万古霉素、替考拉宁进行抗感染治疗,从其疗效、转归     

耐甲氧西林金黄色葡萄球菌感染的临床治疗

目的观察万古霉素及替考拉宁用于MRSA感染治疗的临床疗效,评价万古霉素及替考拉宁在MRSA感染临床治疗中的应用价值。方法选择60例MRSA感染患者,按照随机原则分为例数相等的两组,其中观察组采用万古霉素治疗,对照组采用替考拉宁治疗,治疗一段时间后,对临床疗效进行比较及统计学分析,观察组间是否存在显著性差异。结果观察组30例患者,有效率93.3%（28/30）;对照组30例患者,有效率66.7%（20/30）,经统计学比较,组间差异具有统计学意义（P〈0.05）。结论万古霉素用于MRSA感染的治疗,具有比替考拉宁更为显著的疗效,值得临床推广应用。     

基于指南评估我院治疗耐甲氧西林金黄色葡萄球菌感染的抗菌药物应用

目的:调查我院治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染的抗菌药物使用情况,分析导致抗感染失败的原因。方法:收集2011年在我院进行抗MRSA感染治疗的患者资料,在美国感染性疾病学会2011年发布的《耐甲氧西林金黄色葡萄球菌感染的循证治疗指南》以及我国《耐甲氧西林金黄色葡萄球菌感染防治专家共识》的基础上,从患者的基本情况、感染部位、药敏数据与选用的抗感染药物的品种、剂量、疗程等方面对治疗效果进行评价。结果:我院MRSA感染的治疗方案与指南的推荐基本相符,但仍存在选药不当与用药剂量过小的问题。结论:应充分发挥临床药师的作用,为抗MRSA感染提供服务,提高MRSA感染的治愈率。     

中枢神经系统耐甲氧西林金黄色葡萄球菌感染治疗方案选择

万古霉素、替考拉宁、利奈唑胺是临床常用的治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染的抗菌药物,由于其不同的药代动力学及不良反应特点导致其在临床应用中的侧重点各有不同。由于血脑屏障的存在,中枢神经系统感染尤其是MRSA感染的治疗尤为困难。该研究从药代动力学方面分析了替考拉宁在中枢神经系统感染中的应用以及从药物疗效、药物经济学及药物不良反应三个方面比较了万古霉素脑室给药和利奈唑胺外周静脉给药对于中枢神经系统MRSA感染的优劣,为临床颅内感染治疗方案的选择提供借鉴意义。     

Gram positive infection in trauma patients: new strategies to decrease emerging Gram-positive resistance and vancomycin toxicity

Bacterial resistance to antibiotics has become a serious problem in medicine. Particularly worrisome is the increasing incidence of multi-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Not surprisingly, in view of the high incidence of life-threatening infections and heavy antibiotic use, resistance has become very frequent and problematic in intensive care units. The standard approach for the treatment of MRSA is vancomycin or teicoplanin. Long-term therapeutic and unrestricted prophylactic use of vancomycin has given rise to VRE which in turn may lead to the emergence of vancomycin-resistant S. aureus (VRSA) through plasmid mediated transmission. In order to reduce the incidence of VRE and to avoid the emergence of VRSA, vancomycin use should be restricted and alternative antibiotic strategies should be developed. Using those antibiotics to which MRSA are still generally sensitive, perhaps in combination with new ones, such as, quinupristin/dalfopristin, should be entertained. We performed a retrospective review of the Gram-positive infections in our Level 1 Trauma Center Intensive Care Unit, and an analysis of the resistance patterns of the NMSA infections showed that additional resistance rarely develops within less than 5 days. We then designed a new strategy for the treatment of MRSA infections. This strategy consists of the sequential use of a range of antibiotics with activity against MRSA in short 5-7 day pulses until the full clinical course is completed. Studies validating the benefit of this approach are currently in preparation.     

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.     

A comparison of available and investigational antibiotics for complicated skin infections and treatment-resistant Staphylococcus aureus and enterococcus

This article compares vancomycin, teicoplanin, quinupristin-dalfopristin, linezolid, daptomycin, tigecyline, dalbavancin, telavancin, ceftobiprole, oritavancin, and ramoplanin for the treatment of complicated skin and skin structure infections (cSSSI), methicillin-resistant Staphylococcus aureus (MRSA), enterococcus, and vancomycin-resistant enterococcus. Vancomycin, a glycopeptide antibiotic, is administered intravenously, and is the mainstay of treatment for MRSA and cSSSI. While not available in the U.S., teicoplanin, another glycopeptide antibiotic, can be administered intramuscularly and has simpler dosing and monitoring requirements than vancomycin. Quinupristin/dalfopristin treats vancomycin-resistant Enterococcus faecium (VREF) infections but inhibits cytochrome P450 A3P4, and has only modest activity against MRSA pneumonia. Daptomycin effectively treats cSSSI but not pneumonia caused by MRSA, and is effective against all strains of Staphylococcus. Linezolid, available orally and intravenously, is approved to treat community-acquired and nosocomial pneumonia, cSSSI, and infections caused by MRSA and vancomycin-resistant enterococci including infections with concurrent bacteraemia and VREE Tigecycline, a glycylcycline derived from minocycline, has been approved by the FDA to treat cSSSI and complicated intraabdominal infections, and might be effective against Acinetobacter baumannii; its primary side effect is digestive upset. Dalbavancin, effective against MRSA and administered intravenously once weekly, possesses coverage similar to vancomycin. Telavancin deploys multiple mechanisms of action and is effective against MRSA and Gram-positive bacteria resistant to vancomycin. Ceftobiprole, a cephalosporin effective against MRSA, has few side effects. Oritavancin demonstrates similar activity to vancomycin but possesses extended activity against vancomycin-resistant Staphylococcus and enterococci. Ramoplanin, a macrocyclic depsipeptide, is unstable in the bloodstream but can be taken orally to treat Clostridium difficile colitis.     

头孢吡普抗耐甲氧西林金黄色葡萄球菌活性的研究进展

头孢吡普是新的第5代头孢菌素类抗生素,具有广泛的抗菌谱,尤其具有抗耐甲氧西林金黄色葡萄球菌的活性,本文就对其结构、研究现状、作用机制、抗菌活性与临床应用等方面进行介绍.     

"Non-Antibiotics": alternative therapy for the management of MDRTB and MRSA in economically disadvantaged countries

The antibiotic resistance is now common place throughout the globe. Two highly problematic antibiotic resistant infections are those produced by multi-drug resistant Mycobacterium tuberculosis (MDRTB) and methicillin resistant Staphylococcus aureus (MRSA). Although vancomycin is useful for therapy of MRSA, there is now evidence that resistance to this antibiotic is taking place. Intracellular infections of MRSA are very difficult to manage and are recurrent especially when invasive prosthetic devices are employed. This mini-review provides cogent evidence that both intracellular MDRTB and intracellular MRSA can be killed by concentrations of the non-antibiotic phenothiazine, Thioridazine, at concentrations in the medium that are below those present in the plasma of patients treated with this agent. Although thioridazine has been claimed to cause arrhythmias and even sudden death, the frequencies of these episodes are rare and when present, they are related to the patients underlying cardiac status as opposed to the direct effect of the agent itself. The authors do not suggest that thioridazine be used indiscriminately for MDRTB or intracellular infections produced by MRSA. However, there are circumstances where there are no alternative forms of therapy and the patient faces an unfavourable prognosis. For these highly selective and controlled situations, the use of thioridazine in the manner employed for the therapy of psychosis is recommended (compassionate therapy).     

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.     

Daptomycin, a lipopeptide antibiotic in clinical practice

Gram-positive cocci are one of the leading causes of infections in clinical medicine. Since the invention of antibiotic substances, multidrug resistance is a major problem in the treatment of such infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for 60% of nosocomial infections in the US. The first-choice drug used in these cases is the glycopeptide vancomycin; however, vancomycin is associated with a significant number of adverse side effects, such as nephro- and ototoxicity. Thus, the discovery of new drugs against MRSA and other multidrug-resistant cocci is of utmost interest. Daptomycin, a lipopeptide, is one of these new drugs and has been successfully used in the treatment of complicated skin and skin-structure infections and right-sided endocarditis. Because of its potency and pharmacological profile, it is increasingly used for new indications not yet approved by the FDA. The purpose of this article is to provide an overview of daptomycin, with particular emphasis on potential new indications for which it could be used in the future.     

Emerging drugs on methicillin-resistant Staphylococcus aureus

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has proven to be a prominent pathogen in hospitals and in the community, which is capable of causing a variety of severe infections. Until now, there has been a limited antimicrobial armamentarium for use against MRSA, of which glycopeptides and linezolid are the main agents used.

Areas covered: This review assesses current treatment and the agents being developed for MRSA infections. A search was conducted in PubMed for English-language references published from 2000 to 2013, using combinations of the following terms: ‘MRSA', ‘MRSA therapy', ‘gram (+) infections therapy', ‘new antibiotics', ‘vancomycin', ‘staphylococcus resistance', ‘oritavancin', ‘ceftaroline', ‘linezolid' and ‘tigecycline'. The clinicalTrials website was also searched with keywords regarding the new antibiotic agents against MRSA infections.

Expert opinion: There are a number of new agents, the place of which in therapeutic regimens is yet to emerge. New glycopeptides, such as dalbavancin and oritavancin, with long half-lives, enabling once-weekly dosing, and oral agents, such as iclaprim, may provide a treatment approach for outpatient therapy. A decision must be made regarding the most suitable agent for an individual patient, the site of infection and the place of therapy.     

微生物源抗耐甲氧西林金黄色葡萄球菌天然产物的研究进展

耐甲氧西林金黄色葡萄球菌(MRSA)是目前临床上感染严重的耐药性细菌之一，给人类健康造成了巨大威胁。万古霉素为目前治疗MRSA感染的最后一道防线，但耐万古霉素金黄色葡萄球的出现使对治MRSA新型药物的开发迫在眉睫。微生物是巨大的天然化合物宝库，曾为现代抗生素工业提供了多数主力抗生素。新近研究表明，微生物源天然产物有着良好的对治MRSA的生物活性，有些已经被开发为临床治疗MRSA感染的一线药物。本文从MRSA耐药机理，新型MRSA治疗药物研究的意义，到目前常用治疗MRSA的药物，尤其针对来源于微生物拮抗MRSA的天然产物研究进行了综述，并对未来发展趋势进行了展望。