Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility
Treatment outcomes for serious infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility
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DOI：
10.1086/381202
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发表时间：
2004-02-15
影响因子：
11.8
通讯作者：
Grayson, ML
中科院分区：
文献类型：
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作者：
Howden, BP;Ward, PB;Grayson, ML
虽然包括澳大利亚在内的一些国家已经报道了由耐甲氧西林金黄色葡萄球菌(SA-RVS)引起的万古霉素敏感性降低的感染，但最佳治疗方法尚不清楚。我们回顾了澳大利亚和新西兰25例由SA-RVS引起的严重感染的临床特征、治疗和结果。8例有心内膜炎，9例有菌血症合并深层感染，6例有骨髓炎或化脓性关节炎，2例有脓胸。所有患者在分离SA-RVS前均接受过万古霉素治疗，糖肽治疗失败19例(76%)。21名患者随后接受了积极治疗，16名患者(76%)有效。18例患者接受利奈唑胺治疗，14例(78%)有效，包括4例心内膜炎患者。12名患者接受了利福平和呋西地酸的联合治疗。手术治疗15例(60%)。对于大多数SA-RVS引起的严重感染(包括心内膜炎)患者，抗生素治疗，特别是利奈唑胺与利福平和呋西地酸的联合或联合手术是有效的治疗方法。
Although infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS) have been reported from a number of countries, including Australia, the optimal therapy is unknown. We reviewed the clinical features, therapy, and outcome of 25 patients with serious infections due to SA-RVS in Australia and New Zealand. Eight patients had endocarditis, 9 had bacteremia associated with deep-seated infection, 6 had osteomyelitis or septic arthritis, and 2 had empyema. All patients had received vancomycin before the isolation of SA-RVS, and glycopeptide treatment had failed for 19 patients (76%). Twenty-one patients subsequently received active treatment, which was effective for 16 patients (76%). Eighteen patients received linezolid, which was effective in 14 (78%), including 4 patients with endocarditis. Twelve patients received a combination of rifampicin and fusidic acid. Surgical intervention was required for 15 patients (60%). Antibiotic therapy, especially linezolid with or without rifampicin and fusidic acid, in conjunction with surgical debulking is effective therapy for the majority of patients with serious infections (including endocarditis) caused by SA-RVS.