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首页> 外文期刊>Emerging Infectious Diseases >Methicillin-resistant Staphylococcus aureus Skin Infections
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Methicillin-resistant Staphylococcus aureus Skin Infections

机译：耐甲氧西林金黄色葡萄球菌皮肤感染

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To the Editor: Moran et al. write,"In areas with a high prevalence ofCA-MRSA [community acquiredmethicillin-resistant Staphylococcusaureus], empiric treatment for skinand soft tissue infections (SSTIs) withβ-lactam agents such as cephalexinmay no longer be appropriate. Oralagents such as clindamycin ortrimethoprim/sulfamethoxazole andrifampin should be considered in CA-MRSA" (1). However, some studieshave had different results. Lee et al.reported that 31 (84%) of 37 Texaschildren with CA-MRSA SSTIsshowed clinical improvement afterincision and drainage, even thoughthey received an "ineffective" antimi-crobial agent that was not changedafter the susceptibility results becameavailable (2). These researchers alsoreviewed some reports with similarexperience in the United States andfurther suggested that incision anddrainage without adjunctive antimi-crobial therapy were effective inimmunocompetent children for CA-MRSA SSTIs 8 μg/mL)(4). Fang et al. also reported that 16(55%) of 29 children with CA-MRSASSTIs were eventually cured withtherapy to which their infections werenot susceptible (5). With these experi-ences and concerns about the growingproblem of bacterial resistance, wesuggest that incision and drainage,with or without adjunctive antimicro-bial therapy, are adequate to treat non-invasive CA-MRSA SSTIs inimmunocompetent children and thatoxacillin or first-generation cephalo-sporins are still effective and suffi-cient under such conditions.Vancomycin and other agents that areeffective against MRSA isolatesshould be reserved for invasive CA-MRSA infections or for immunocom-promised patients. Although Moran'sstudy was focused on adults, not onchildren as these studies were, webelieve these suggestions are alsoappropriate when applied to CA-MRSA SSTIs in adults
机译：致编辑：Moran等。写道：“在CA-MRSA [社区获得性耐甲氧西林的葡萄球菌]患病率高的地区，用β-内酰胺类药物（如头孢氨苄）对皮肤和软组织感染（SSTI）进行经验性治疗可能不再合适。诸如克林霉素或甲氧苄啶/磺胺甲恶唑和利福平等口服药物应该在CA-MRSA中考虑”（1）。但是，一些研究得出了不同的结果。 Lee等人报告说，在37名得克萨斯州CA-MRSA SSTI患儿中，有31名（84％）在切开引流后表现出临床改善，即使他们接受的“无效”抗微生物剂在药敏结果可用后也没有改变（2）。这些研究人员还回顾了美国的一些类似经验的报道，并进一步提出，在无免疫能力的儿童中，切开引流对于8μg/ mL的CA-MRSA SSTIs是免疫有效的儿童（4）。方等。还报道了29名CA-MRSASSTIs儿童中的16％（55％）最终通过不易感染的疗法治愈了（5）。有了这些经验和对细菌耐药性日益增长的问题的关注，我们建议切开和引流，无论是否进行辅助抗菌治疗，都足以治疗无免疫力的儿童和撒沙西林或第一代头孢菌素的无创CA-MRSA SSTIs。在这种情况下，孢子蛋白仍然有效且足够。应将万古霉素和其他对MRSA分离物有效的药物保留用于侵袭性CA-MRSA感染或免疫承诺的患者。尽管Moran的研究主要针对成年人，而不是像这些研究那样针对儿童，但将这些建议应用于成年人的CA-MRSA SSTI时，通过网络获取这些建议也是合适的

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