Methicillin-resistant Staphylococcus aureus
Methicillin-resistant Staphylococcus aureus
复制标题
DOI：
10.1038/nrdp.2018.33
复制
发表时间：
2018-05-31
影响因子：
81.5
通讯作者：
Harbarth, Stephan
中科院分区：
文献类型：
--
作者：
Lee, Andie S.;de Lencastre, Herminia;Harbarth, Stephan
自20世纪60年代以来，耐甲氧西林金黄色葡萄球菌(MRSA)出现并在全球传播，成为卫生保健和社区环境中细菌感染的主要原因。然而，由于几个因素，包括当地感染控制做法和循环克隆的病原体特定特征的差异，MRSA的负担在地理上存在显著差异。不同的MRSA克隆是由几个金黄色葡萄球菌克隆独立获得的葡萄球菌盒式染色体mec(SCCmec)，该染色体含有编码蛋白质的基因，使细菌对大多数β-内酰胺类抗生素(如甲氧西林)具有耐药性。耐甲氧西林金黄色葡萄球菌的成功是金黄色葡萄球菌产生的大量毒力因子与β-内酰胺耐药相结合的结果，对大多数克隆人来说，对其他抗生素类别的耐药性。MRSA的临床表现包括无症状的鼻黏膜定植，轻微的皮肤和软组织感染，以及高死亡率的暴发性侵袭性疾病。尽管耐甲氧西林金黄色葡萄球菌的治疗选择有限，但几种新的抗菌药正在开发中。了解定居动态、传播途径、发展为感染的风险因素以及促进出现耐药性的条件，将使优化战略以有效控制耐甲氧西林金黄色葡萄球菌。候选疫苗也在开发中，可能成为一种有效的预防措施。
Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged, disseminated globally and become a leading cause of bacterial infections in both health-care and community settings. However, there is marked geographical variation in MRSA burden owing to several factors, including differences in local infection control practices and pathogen-specific characteristics of the circulating clones. Different MRSA clones have resulted from the independent acquisition of staphylococcal cassette chromosome mec (SCCmec), which contains genes encoding proteins that render the bacterium resistant to most beta-lactam antibiotics (such as methicillin), by several S. aureus clones. The success of MRSA is a consequence of the extensive arsenal of virulence factors produced by S. aureus combined with beta-lactam resistance and, for most clones, resistance to other antibiotic classes. Clinical manifestations of MRSA range from asymptomatic colonization of the nasal mucosa to mild skin and soft tissue infections to fulminant invasive disease with high mortality. Although treatment options for MRSA are limited, several new antimicrobials are under development. An understanding of colonization dynamics, routes of transmission, risk factors for progression to infection and conditions that promote the emergence of resistance will enable optimization of strategies to effectively control MRSA. Vaccine candidates are also under development and could become an effective prevention measure.