Diagnosis and management of Staphylococcus aureus bacteraemia
Diagnosis and management of Staphylococcus aureus bacteraemia
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DOI：
10.1111/j.1444-0903.2005.00977.x
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发表时间：
2005-12-01
影响因子：
2.1
通讯作者：
Howden, BP
中科院分区：
文献类型：
--
作者：
Mitchell, DH;Howden, BP
金黄色葡萄球菌菌血症（SAB）是常见的。澳大利亚每年发生约8000例病例，其中60%与医院或医疗保健有关。SAB的危险因素包括注射药物使用、血液透析、留置血管导管和免疫抑制。高达三分之一的SAB患者发生转移性感染，关节和心脏瓣膜是最常见的受影响部位。社区获得性、持续发热、治疗48小时后血培养阳性和栓塞性病变的存在与复杂性SAB的存在相关（即心内膜炎和/或其他转移性并发症的高风险）。所有患者都需要仔细的临床评估，以排除心内膜炎和其他转移灶。应进行超声心动图检查，最好是经食管超声心动图检查，以排除心内膜炎。大多数SAB患者，以及所有具有复杂SAB特征的患者，需要长期静脉抗生素治疗（至少4周），但具有良好预后特征的亚组可能适合于较短的静脉治疗（2周）。青霉素酶耐药青霉素（E. G.氟氯西林）是甲氧西林敏感菌株SAB的选择药物。万古霉素或第一代头孢菌素是替代品，但其抗菌活性低于氟氯西林。然而，万古霉素仍然是治疗SAB的选择，由于耐甲氧西林菌株。在选定的患者中，庆大霉素联合治疗可能在治疗的最初几天有用，但除此之外，很少有数据支持在SAB中使用联合治疗方案。较新的药物如利奈唑胺和奎奴普汀/达福普汀可能在特定患者中发挥作用，特别是在由S.金黄色葡萄球菌菌株对万古霉素的敏感性降低。
Staphylococcus aureus bacteraemia (SAB) is common. Around 8000 cases occur per year in Australia, of which 60% are hospital- or healthcare-associated. Risk factors for SAB include injectable drug use, haemodialysis, indwelling vascular catheters and immunosuppression. Metastatic infection develops in up to one-third of patients with SAB, with joints and heart valves being the most commonly affected sites. Community-acquisition, persistent fever, positive blood cultures after 48 h of treatment and the presence of embolic lesions correlate with the presence of complicated SAB (i.e. high risk of endocarditis and/or other metastatic complications). All patients require careful clinical evaluation to exclude endocarditis and other metastatic foci. Echocardiography, preferably transoesophageal echocardiography, should be performed to exclude endocarditis. Most patients with SAB, and all with features of complicated SAB, require prolonged intravenous antibiotic therapy ( at least 4 weeks), but a subgroup with good prognostic features may be suitable for shorter intravenous therapy ( 2 weeks). Penicillinase-resistant penicillins ( e. g. flucloxacillin) are the agents of choice for SAB with methicillin-sensitive strains. Vancomycin or first-generation cephalosporins are alternatives but have lower antimicrobial activity than flucloxacillin. However, vancomycin remains the therapy of choice for SAB due to methicillin-resistant strains. Combination therapy with gentamicin may be useful for the first few days of treatment in selected patients, but otherwise there are few data to support the use of combination regimens in SAB. Newer agents such as linezolid and quinupristin/ dalfopristin may have a role in selected patients, especially in SAB due to S. aureus strains with reduced susceptibility to vancomycin.