2009年有关MRSA的进展文献

David

Clinical Microbiology Newsletter
Volume 31, Issue 3, 1 February 2009, Pages 17-23

Clinical Microbiology Newsletter Understanding the Evolution of Methicillin-Resistant Staphylococcus aureus
MRSA的进化

JiYeon Kim M.D., M.P.H.

                               
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, a,

                               
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aClinical Pathology Resident, Massachusetts General Hospital, Boston, Massachussetts


Available online 23 January 2009.


AbstractStaphylococcus aureus is a gram-positive coccus that is among the most adaptable of pathogenic bacteria, particularly in developing resistance to antibiotics. The emergence of strains resistant to all current antibiotics is a real and growing concern. Understanding how S. aureus acquires drug resistance and spreads within health care institutions and communities is critical in developing containment strategies. Molecular typing strategies have become powerful tools in this regard, providing key insights regarding the evolution of S. aureus. This article reviews the current knowledge on the origins of methicillin resistance, the background of early resistant strains, and the changing landscape of drug-resistant S. aureus, particularly in the community setting.

David

b]Published Online: 2 Mar 2009
EDITORIAL
New insights concerning methicillin-resistant Staphylococcus aureus disease
评论：MRSA疾病的新观点
Corresponding author and reprint request: R. Cauda, Istituto Clinica Malattie Infettive, Università Cattolica, L.go F. Vito 8, 00168 Roma, Italy
E-mail: rcauda@rm.unicatt.it
Copyright Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases
ABSTRACT
No Abstract

David

b]Published Online: 2 Mar 2009
REVIEW
Laboratory tools and strategies for methicillin-resistant Staphylococcus aureus screening, surveillance and typing: state of the art and unmet needs
MRSA筛查、监测和分型：实验室方法和策略进展
M. J. Struelens 1 , P. M. Hawkey 2 , G. L. French 3 , W. Witte 4 and E. Tacconelli 5  1) Department of Clinical Microbiology, Université Libre de Bruxelles-Hopital Erasme, Brussels, Belgium ,  2) Public Health Laboratory, Birmingham Heartlands Hospital, Birmingham ,  3) Department of Infection, St Thomas's Hospital, London, UK ,  4) Robert Koch Institute, Wernigerode, Germany and  5) Department of Infectious Diseases, Catholic University, Rome, Italy
Corresponding author and reprint requests: M. J. Struelens, Department of Clinical Microbiology, Université Libre de Bruxelles, Hopital Erasme, 808, route de Lennik, B-1070-Brussels Belgium
E-mail:marc.struelens@ulb.ac.be
Copyright Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases
KEYWORDS
Carrier state ? cross-infection ? cross-over studies ? DNA typing ? epidemiology ? incidence ? infection control ? mass screening ? methicillin resistance ? patient admission ? PCR ? prevention and control ? prospective studies ? review ? standards ? staphylococcal infections ? Staphylococcus aureus ? surveillance
ABSTRACT
The public health burden caused by methicillin-resistant Staphylococcus aureus (MRSA) infections is now widely recognized, and is a cause of public alarm. Effective MRSA risk management in the healthcare system as well as in the community should rely on accurate detection of reservoirs and sources of transmission, as well as on close monitoring of the impact of interventions on disease incidence and bacterial dissemination. MRSA carrier screening and disease surveillance, coupled with molecular typing, are key information tools for integrated MRSA control and individual risk assessment. These tools should be tailored to the distinct needs of local interventions and national prevention programmes. Surveillance schemes should primarily inform local staff and serve as quality assurance about MRSA risk management. New technologies, including the use of selective culture media and real-time PCR assays, allow faster detection of MRSA carriers upon admission or during stay in healthcare institutions. More research is needed to ascertain their cost-effectiveness for MRSA control. Likewise, tremendous progress has been made concerning molecular typing methods, with optimization and standardization of sequence-based technologies offering broad applicability and high throughput. However, no single S. aureus typing method is yet providing fully reliable information within the range of discrimination needed for public health action. Further refinement of genotyping methods and international harmonization of surveillance and typing schemes must be achieved to facilitate global MRSA control.

David

b]Published Online: 2 Mar 2009
REVIEW
Management of methicillin-resistant Staphylococcus aureus infections
MRSA感染的管理
J. Garau 1 , E. Bouza 2 , J. Chastre 3 , F. Gudiol 4 and S. Harbarth 5  1) Department of Medicine, Hospital Universitari Mutua de Terrassa, Terrassa ,  2) Service of Clinical Microbiology and Infectious Diseases, Hospital Universitario Gregorio Marañón, Madrid, Spain ,  3) Institut de Cardiologie, Hôpital Pitié Sal pêtrière, Paris, France ,  4) Service of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain and  5) Infection Control Program, Geneva, Switzerland
Corresponding author and reprint requests: J. Garau, Department of Medicine, Hospital Universitari Mutua de Terrassa, Plaza Dr Robert, 5, 08221 Terrassa, Barcelona, Spain
E-mail: xgarau@mutuaterrassa.es
Copyright Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases
KEYWORDS
Bacteraemia ? endocarditis ? MRSA ? review ? vancomycin
ABSTRACT
This review addresses selected aspects of the management of severe healthcare-associated infections due to methicillin-resistant Staphylococcus aureus (MRSA), including the limitations of current therapy, potential alternative agents, new therapeutic options, clinical approaches to MRSA bacteraemia/endocarditis and ventilator-associated pneumonia, and strategies to improve outcomes in patients with severe MRSA infections.

David

b]Published Online: 2 Mar 2009
REVIEW
Prevention and control of methicillin-resistant Staphylococcus aureus
MRSA的预防和控制
Corresponding author and reprint requests: H. Humphreys, Department of Clinical Microbiology, Education and Research Centre, Beaumont Hospital, PO Box 9063, Dublin 9, Ireland
E-mail:hhumphreys@rcsi.ie
Copyright Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases
KEYWORDS
Decolonization ? disinfection/cleaning ? hand hygiene ? isolation/cohorting ? MRSA ? patient transfer/discharge ? review
ABSTRACT
Recent efforts to combat infections have focused on pharmaceutical interventions. However, the global spread of antimicrobial resistance calls for the reappraisal of personal and institutional hygiene. Hygiene embodies behavioural and procedural rules that prevent bacterial transmission. Consequently, the chance of spreading bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) is significantly reduced. Hygiene is part of the primacy and totality of patient care, ensuring that no harm is done. Any prevention and control strategy must be underpinned by changes in attitude, embraced by all. The major components of preventing and controlling MRSA include hand and environmental hygiene (as part of standard precautions), patient isolation, and patient/staff decolonization. Improving hand hygiene practice is especially important where the risk of infection is highest, e.g. in intensive care. Physical isolation has two advantages: the physical barrier interrupts transmission, and this barrier emphasizes that precautions are required. With limited isolation facilities, risk assessment should be conducted to indicate which patients should be isolated. Environmental hygiene, although important, has a lower priority than standard precautions. When a patient is ready for discharge (home) or transfer (to another healthcare facility), the overall interests of the patient should take priority. All patients should be informed of their MRSA-positive status as soon as possible. Because of increased mupirocin resistance, a selective approach to decolonization should be taken. When MRSA-positive staff are identified, restricting their professional activity will depend on the nature of their work. Finally, politicians and others need to commit to providing the necessary resources to maximize MRSA prevention and control.

David

b]Published Online: 28 Jan 2009
ORIGINAL ARTICLE
The population structure of Staphylococcus aureus among general practice patients from The Netherlands
荷兰一般患者中MRSA携带者的人群结构
G. A. Donker 1 , R. H. Deurenberg 2 , C. Driessen 2 , S. Sebastian 2 , S. Nys 2 and E. E. Stobberingh 2  1) Netherlands Institute for Health Services Research (NIVEL), Utrecht and  2) Department of Medical Microbiology, University Hospital Maastricht, Maastricht, The Netherlands
Corresponding author and reprint requests: R. H. Deurenberg, Department of Medical Microbiology, Maastricht Infection Centre (MINC) University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands
E-mail: ruud.deurenberg@mumc.nl
Copyright Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases
KEYWORDS
Antibiotic resistance ? general practitioner ? S. aureus ? spa typing ? The Netherlands
ABSTRACT
To investigate the prevalence, the antibiotic resistance pattern and the population structure of Staphylococcus aureus, S. aureus isolates from the anterior nostrils of patients of general practitioners (GPs) were analysed. Insight into the S. aureus population structure is essential, as nasal carriers of S. aureus are at increased risk of developing an S. aureus infection. S. aureus was isolated from nasal swabs from 2691 patients with no sign of an infection collected in 29 GP practices in The Netherlands. The susceptibility pattern for several classes of antibiotics was determined, as well as the S. aureus genetic background, using spa typing. S. aureus was isolated from 617 of the 2691 (23%) nasal swabs. The prevalences of resistance to ciprofloxacin, co-trimoxazole, fusidic acid, macrolides and mupirocin were 0.2%, 0%, 6%, 5% and 1%, respectively. Half of the isolates were associated with a genetic background common to the major methicillin-resistant S. aureus (MRSA) clones, e.g. clonal complex (CC)1, CC5, CC8, CC22, CC30 and CC45, and the remainder were mainly associated with CC7, CC12, CC15, CC26, CC51 and CC101. The low prevalences of resistance suggest that, in the Dutch situation, S. aureus isolates from patients visiting their GP because of complaints not related to infection do not represent a large reservoir of antibiotic resistance genes. Although no MRSA isolates were found, the genetic background of some of the S. aureus isolates is commonly observed among community-associated (CA)-MRSA clones (CC1, CC8 and CC30), and this might suggest that these isolates have the potential to become CA-MRSA.

David

b]Published Online: 12 Jan 2009
ORIGINAL ARTICLE
Serum antibodies against Panton–Valentine leukocidin in a normal population and during Staphylococcus aureus infection
一般人群和金葡菌感染患者血清中抗PVL抗体滴度比较
Corresponding author and reprint requests: G. Lina, Centre National de Référence des Staphylocoques, INSERM U851, 7 rue Guillaume Paradin, 69372 Lyon cedex 08, France
E-mail: gerard.lina@chu-lyon.fr
Copyright Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases
KEYWORDS
Antibody ? human ? infection ? Panton–Valentine leukocidin ? Staphylococcus aureus
ABSTRACT
To determine whether Staphylococcus aureus Panton–Valentine leukocidin (PVL) is expressed during human infection, anti-PVL antibody titres were compared in patients with PVL-positive and PVL-negative staphylococcal infections, and in patients with no evidence of S. aureus infection. Patients with PVL-positive strains had higher levels of anti-PVL antibodies than individuals of both control groups. The median anti-PVL titre increased 8.6-fold during the course of PVL-positive infection and 1.4-fold during PVL-negative infection. These results indicate that only PVL-positive S. aureus strains elicit significant anti-PVL antibody production in humans, and demonstrate the production of PVL during PVL-positive S. aureus infection. The protective role of this immune response remains to be established.

David

b]Published Online: 12 Jan 2009
ORIGINAL ARTICLE
Nasal carriage of Staphylococcus aureus, including community-associated methicillin-resistant strains, in Queensland adults
昆士兰成人鼻咽部金葡菌（包括CA-MRSA）的携带情况
Corresponding author and reprint requests: W. J. Munckhof, Infection Management Service, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland, Australia 4102
E-mail: wendy_munckhof@health.qld.gov.au
Copyright Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases
KEYWORDS
Community-acquired infections ? epidemiology ? methicillin-resistant Staphylococcus aureus ? Panton–Valentine leukocidin ? staphylococcal infections ? Staphylococcus aureus ? surveillance
ABSTRACT
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are emerging in southeast Queensland, Australia, but the incidence of carriage of CA-MRSA strains is unknown. The aim of this study was to assess the nasal carriage rate of S. aureus, including CA-MRSA strains, in the general adult population of southeast Queensland. 396 patients presenting to general practices in two Brisbane suburbs and 303 volunteers randomly selected from the electoral rolls in the same suburbs completed a medical questionnaire and had nasal swabs performed for S. aureus. All isolates of S. aureus underwent antibiotic susceptibility testing and single-nucleotide polymorphism (SNP) and binary typing, including determination of Panton–Valentine leukocidin (PVL). The nasal carriage rate of methicillin-susceptible S. aureus (MSSA) was 202/699 (28%), a rate similar to that found in other community-based nasal carriage studies. According to multivariate analysis, nasal carriage of S. aureus was associated with male sex, young adult age group and Caucasian ethnicity. Only two study isolates (one MSSA and one CA-MRSA) carried PVL. The nasal carriage rate of MRSA was low, at 5/699 (0.7%), and only two study participants (0.3%) had CA-MRSA strains. CA-MRSA is an emerging cause of infection in southeast Queensland, but as yet the incidence of carriage of CA-MRSA in the general community is low.

esuoting

么意思，要找人翻译吗？有加分吗:lol

thornbird

David,有没有好一点的masa控制评价指标啊