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Staphylococcus aureus

机译：金黄色葡萄球菌

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PURPOSE: To review the clinical features and treatment of common bacterial infections of the skin and soft tissue, the increasing prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), and its impact on treatment decisions. EPIDEMIOLOGY: Skin and soft-tissue infections account for about 7% to 10% of hospitalizations in North America, and upwards of 2.5% of primary care office visits. MRSA is a common cause of bacterial infection in hospitals, accounting for 40% to 70% of total S aureus infections. Traditionally a hospital pathogen, MRSA has become increasingly common in community settings. CA-MRSA has been seen both sporadically and in local outbreaks. REVIEW SUMMARY: The increasing prevalence of MRSA has had a considerable impact, however clinicians cannot often reliably anticipate CA-MRSA. CA-MRSA tends to affect children and younger adults with an emphasis on skin and soft-tissue infections whereas hospital-acquired MRSA is more common among the older adult population, typically causing bacteremia and deep infections. The approach to pharmacologic therapy or these infections may require modification of the historical long-term reliance upon β-lactam antibiotics, instead using different drugs while increasing the emphasis upon incision and drainage. TYPE OF AVAILABLE EVIDENCE: Randomized controlled trials, randomized studies, prospective and retrospective cohort studies, unstructured reviews, and conference proceedings/presentation slides. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: Pharmacologic treatment of skin and soft-tissue infections, especially in the community setting, may require consideration of drugs targeting MRSA, though whether this needs to be empiric or based on culture results is subject to debate. Incision and drainage of cutaneous abscesses including culturing of material have become particularly important for proper management.
机译：目的：回顾皮肤和软组织常见细菌感染的临床特征和治疗，社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）的患病率及其对治疗决策的影响。流行病学：在北美，皮肤和软组织感染约占住院人数的7％至10％，在初级保健办公室就诊中占2.5％以上。 MRSA是医院细菌感染的常见原因，占总金黄色葡萄球菌感染的40％至70％。传统上，MRSA是医院病原体，在社区环境中已变得越来越普遍。 CA-MRSA既偶然出现，也出现在局部暴发中。综述：MRSA的日益流行已产生相当大的影响，但是临床医生通常不能可靠地预测CA-MRSA。 CA-MRSA倾向于影响儿童和年轻人，重点是皮肤和软组织感染，而医院获得的MRSA在老年人群中更为常见，通常引起菌血症和深层感染。药物治疗或这些感染的方法可能需要修改对β-内酰胺抗生素的长期历史依赖，而不是使用其他药物，同时增加对切口和引流的重视。可用证据的类型：随机对照试验，随机研究，前瞻性和回顾性队列研究，非结构化评价以及会议记录/演示幻灯片。可用的证据等级：很好。结论：皮肤和软组织感染的药物治疗，尤其是在社区环境中，可能需要考虑针对MRSA的药物，尽管是否需要经验性还是基于培养结果尚有争议。皮肤脓肿的切开引流，包括材料的培养，对于正确处理已变得尤为重要。

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