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Increasing Antibiotic Resistance among Methicillin-Resistant Staphylococcus aureus Strains

机译：耐甲氧西林金黄色葡萄球菌菌株中抗生素耐药性的提高

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摘要

Vancomycin use has increased dramatically worldwide since the mid-1980s, largely as a result of empirical and directed therapy against burgeoning methicillin-resistant Staphylococcus aureus (MRSA) infections. With limited choices, clinicians have traditionally relied on vancomycin alone in the management of serious MRSA infections and have enjoyed a significant period free of vancomycin resistance in S. aureus. Even now, 5 decades after its introduction, vancomycin resistance among S. aureus strains, as currently defined microbiologically, remains rare. Yet it is becoming clear that vancomycin is losing potency against S. aureus, including MRSA. Serious infections due to MRSA defined as susceptible in the laboratory are not responding well to vancomycin. This is demonstrated by increased mortality seen in patients with MRSA infection and markedly attenuated vancomycin efficacy caused by vancomycin heteroresistance in S. aureus. Therefore, it appears that our definition of vancomycin susceptibility requires further scrutiny as applied to serious MRSA infections, such as bacteremia and pneumonia.
机译：自1980年代中期以来，万古霉素的使用在世界范围内急剧增加，这主要是由于针对甲氧西林耐药的新兴金黄色葡萄球菌（MRSA）感染的经验和定向疗法的结果。由于选择范围有限，临床医生传统上仅依靠万古霉素来治疗严重的MRSA感染，并且在金黄色葡萄球菌中享有相当长的一段时间对万古霉素没有耐药性。即使到现在，在引入后的5年中，按照目前的微生物学定义，金黄色葡萄球菌菌株对万古霉素的耐药性仍然很少。然而，越来越明显的是万古霉素对包括金黄色葡萄球菌在内的金黄色葡萄球菌正在丧失效力。在实验室中定义为易感的MRSA引起的严重感染对万古霉素反应不良。这可以通过在MRSA感染患者中看到的死亡率增加和金黄色葡萄球菌中万古霉素异抗性导致的万古霉素功效显着减弱来证明。因此，似乎我们对万古霉素敏感性的定义需要进一步审查，以应用于严重的MRSA感染，例如菌血症和肺炎。

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  • 来源
    《Clinical Infectious Diseases》 |2008年第5期|p.360-367|共8页
  • 作者

    George Sakoulas1 and Robert C. Moellering Jr.2;

  • 作者单位

    1Division of Infectious Diseases, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York 2Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachussetts;

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