Methicillin-Resistant S. aureus Ventilator-Associated Pneumonia: Strategies to Prevent and Treat.
Methicillin-Resistant S. aureus Ventilator-Associated Pneumonia: Strategies to Prevent and Treat.
复制标题
耐甲氧西林金黄色葡萄球菌呼吸机相关肺炎：预防和治疗策略。
DOI：
10.1055/s-2006-933677
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发表时间：
2006
影响因子：
3.2
通讯作者：
Wunderink,RichardG
中科院分区：
文献类型：
--
作者：
Lam,AnnaP;Wunderink,RichardG
耐甲氧西林金黄色葡萄球菌（MRSA）引起的呼吸机相关性肺炎（VAPs）发病率不断上升，对其预防和治疗提出了独特的挑战。发生MRSA VAP的危险因素包括鼻载、既往抗生素治疗、长时间机械通气、不良感染控制措施、头部创伤/昏迷和病毒感染。预防MRSA VAP发展的措施包括VAP的一般预防策略和减少金黄色葡萄球菌鼻腔携带。金黄色葡萄球菌具有多种可转移的遗传元件，其编码的蛋白质赋予对几种抗生素的抗性，包括β-内酰胺和糖肽。目前可用的抗生素对MRSA VAP的成功治疗一直很差。目前的管理指南推荐糖肽作为MRSA VAP的初始治疗。然而，万古霉素的成功率很低，只有35%到57%。这可能是由于万古霉素进入肺部的渗透性差，增加组织水平的替代给药方案需要进一步研究。利奈唑胺能很好地渗透到肺中，治疗与更高的治愈率和生存率相关。需要进一步的数据来评估新抗生素对MRSA VAP的疗效。
Ventilator-associated pneumonias (VAPs) due to methicillin-resistant Staphylococcus aureus (MRSA) are rising in incidence and pose unique challenges in their prevention and treatment. Risk factors for the development of MRSA VAP include nasal carriage, prior antibiotic therapy, prolonged mechanical ventilation, poor infection control practices, head trauma/coma, and viral infection. Measures to prevent the development of MRSA VAP include general VAP prevention strategies and reduction of S. aureus nasal carriage. S. aureus possesses a variety of transferable genetic elements that encode proteins conferring resistance to several antibiotics, including β-lactams and glycopeptides. Successful treatment of MRSA VAP with currently available antibiotics has been poor. Current management guidelines recommend glycopeptides as initial therapy for MRSA VAP. However vancomycin success rates are low, ranging from only 35 to 57%. This may be due to the poor penetration of vancomycin into the lung, and alternate dosing regimens to increase tissue levels need to be further studied. Treatment with linezolid, which penetrates well into the lung, is associated with higher cure and survival rates. Further data are needed to evaluate the efficacy of new antibiotics in MRSA VAP.