Methicillin-Resistant Staphylococcus aureus in Diabetic Foot Infections
Methicillin-Resistant Staphylococcus aureus in Diabetic Foot Infections
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DOI：
10.2165/11538070-000000000-00000
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发表时间：
2010-01-01
期刊：
影响因子：
11.5
通讯作者：
Boulton, Andrew J.
中科院分区：
文献类型：
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作者：
Eleftheriadou, Loanna;Tentolouris, Nicholas;Boulton, Andrew J.
糖尿病足溃疡往往并发感染。在病原体中，金黄色葡萄球菌占主导地位。耐甲氧西林链球菌的感染率为100%。金黄色葡萄球菌（MRSA）在感染性足部溃疡中的感染率为15-30%，并且在许多国家存在令人担忧的增加趋势。也有数据表明新的耐万古霉素的MRSA菌株。在存在骨髓炎、鼻腔携带MRSA、既往使用抗菌药物或住院治疗、溃疡面积较大和溃疡持续时间较长的情况下，MRSA分离的风险增加。在MRSA感染的患者中，截肢和手术清创的需要增加。社区获得性MRSA引起的轻度或中度感染可在获得药敏结果时使用复方新诺明（甲氧苄啶/磺胺甲恶唑）、强力霉素或克林霉素治疗，而严重的社区获得性或医院获得性MRSA感染应使用糖肽类、利奈唑胺或达托霉素治疗。达巴万星、替加环素和头孢吡普是新的有前途的抗MRSA抗菌药物，如果有更多关于其疗效和安全性的数据，它们也可能在治疗足部感染中发挥作用。
Diabetic foot ulcers are often complicated by infection. Among pathogens, Staphylococcus aureus predominates. The prevalence of methicillin-resistant S. aureus (MRSA) in infected foot ulcers is 15-30% and there is an alarming trend for increase in many countries. There are also data that recognize new strains of MRSA that are resistant to vancomycin. The risk for MRSA isolation increases in the presence of osteomyelitis, nasal carriage of MRSA, prior use of antibacterials or hospitalization, larger ulcer size and longer duration of the ulcer. The need for amputation and surgical debridement increases in patients infected with MRSA. Infections of mild or moderate severity caused by community-acquired MRSA can be treated with cotrimoxazole (trimethoprim/sulfamethoxazole), doxycycline or clindamycin when susceptibility results are available, while severe community-acquired or hospital-acquired MRSA infections should be managed with glycopeptides, linezolide or daptomycin. Dalbavancin, tigecycline and ceftobiprole are newer promising antimicrobial agents active against MRSA that may also have a role in the treatment of foot infections if more data on their efficacy and safety become available.