甲氧西林耐药金黄色葡萄球菌感染临床治疗现状及进展  

Treatment advances of methicillin-resistant Staphylococcus aureus associated clinical infections Yuan

作　　者：袁莉莉[1] 李光辉[2] 

机构地区：[1]复旦大学附属华山医院医院感染管理科,上海200040 [2]复旦大学附属华山医院医院抗生素研究所,上海200040

出　　处：《中华临床感染病杂志》2016年第4期299-306,共8页Chinese Journal of Clinical Infectious Diseases

摘　　要：甲氧西林耐药金黄色葡萄球菌（ MRSA）是医院感染常见的致病菌，可导致肺炎、血流感染、感染性心内膜炎、皮肤软组织感染、骨关节感染等感染性疾病，给临床治疗带来巨大的挑战。万古霉素依然是抗MRSA感染的经典用药，但临床使用时需要通过药代动力学／药效动力学（ PK／PD ）调整治疗方案。在体外试验中，脂糖肽类抗生素表现出良好的抗菌活性，但其长半衰期和复杂的PK／PD参数限制了在重症患者中的应用。抗MRSA的头孢菌素类药物的耐药和使用情况存在相关性，临床应慎用。目前，除利奈唑胺在治疗MRSA感染所致医院获得性肺炎时的疗效优于万古霉素外，其他抗菌药物在治疗MRSA感染时均未显示出优于万古霉素的疗效。同属恶唑烷酮类的泰地唑胺生物利用度更高，不良反应发生率更低，但其临床应用仍有待更多研究验证。在MRSA所致的血流感染中，达托霉素的疗效与万古霉素相近，因此推荐为抗MRSA血流感染的一线用药之一。其他如奎奴普丁／达福普汀和替加环素等药物在用于治疗MRSA所致的重症感染方面缺乏研究依据，仅在其他抗MRSA药物无法取得临床疗效时被考虑。利福平、庆大霉素、磷霉素、磺胺甲噁唑-甲氧苄啶等药物可能存在联合治疗的价值，但仍缺乏循证学依据。Methicillin-resistant Staphylococcus aureus （ MRSA） is a common clinic pathogen for＆amp;nbsp;nosocomial infections, such as pneumonia, bloodstream infection, endocarditis, skin soft-tissue infection, and osteoarticular infection, which brings giant challenge for clinic treatment.Vancomycin remains an acceptable treatment option, but it needs to be adjusted by pharmacokinetic/pharmacodynamic （ PK/PD ） parameters.Lipoglycopeptides show excellent antimicrobial activity in vitro, but their long half-lives and complex PKs may preclude these agents being used in critically ill patients.Anti-MRSA cephalosporins were reported to be associated with the emergence of its antimicrobial resistance, so clinicians should be cautious when employing these kinds of antibiotics in clinical practice.So far, only linezolid has been proved with better performance than vancomycin for the treatment of hospital acquired pneumonia due to MRSA. Tedizolid, which is also categorized as Oxazolidinone, has higher bioavailability with lower rate of adverse events, but more investigation and validation are still needed for clinic application.Daptomycin displays similar performance with vancomycin on bloodstream infection due to MRSA, so it is recommended as the main drug for the treatment of MRSA associated bloodstream infection.Others such as quinupristin/dalfopristin and tigecycline are all lack of clinical evidence on the treatment of MRSA associated severe infections, so they are only considered when other anti-MRSA drugs showing inferior clinical effects. Rifampicin, Gentamicin, Fosfomycin, Sulfamethoxazole-Trimethoprim and other drugs may be administered for combination therapy, but clinical evidence is still lacking.

关 键 词：葡萄球菌 金黄色 甲氧西林抗药性 抗菌药 治疗 

分 类 号：R446.5[医药卫生—诊断学]