万古霉素敏感性下降对治疗MRSA血流感染效果的影响

David

Research
Impact of reduced vancomycin susceptibility on the therapeutic outcome of MRSA bloodstream infections
万古霉素敏感性下降对治疗MRSA血流感染效果的影响
Hui-min Neoh1 , Satoshi Hori2 , Mitsutaka Komatsu3 , Toyoko Oguri4 , Fumihiko Takeuchi2 , Longzhu Cui1,2  and Keiichi Hiramatsu1,2

1Department of Bacteriology, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan

2Infection Control Science, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan

3Paediatrics, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan

4Clinical Laboratory of Juntendo Hospital, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421 Japan

author email corresponding author email

Annals of Clinical Microbiology and Antimicrobials 2007, 6:13doi:10.1186/1476-0711-6-13

Received: 30 July 2007
Accepted: 30 October 2007
Published: 30 October 2007

Abstract
Background
The aim of this study was to determine whether clinical outcome of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia was correlated with vancomycin susceptibility of the corresponding strains.

Methods
A retrospective study on MRSA bacteraemia was performed at a teaching hospital between January 1998 and October 2005 by linking vancomycin susceptibility profiles of patients' isolates with hospitalization data.

Results
A total of 20 out of 209 MRSA bacteraemia patients were treated with vancomycin for at least 5 days with adequate trough levels, and fulfilled the study's inclusion and exclusion criteria. Twenty-two S. aureus isolates from these patients' blood cultures were identified as MRSA, including two hetero-VISA from separate patients and two VISA with vancomycin MIC of 4 mg/L from one patient. Between patients who showed 'good' vancomycin response and patients who did not, there was a significant difference (p < 0.01) in their corresponding MRSAs' vancomycin susceptibility expressed by 'area under curve' (AUC) of population analysis. Significant correlations were found between AUC and initial vancomycin therapeutic response parameters of 'days till afebrile' (r = 0.828, p < 0.01) and 'days till CRP ≦ 30% of maximum' (r = 0.627, p < 0.01)

Conclusion
Our study results caution healthcare personnel that early consideration should be given to cases with a poor vancomycin treatment response that could signify the involvement of MRSA with reduced susceptibility to vancomycin.

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fyk8595

D版主，能否为俺们提供中文版？先谢啦

David

Abstract(摘要)
Background（背景）
The aim of this study was to determine whether clinical outcome of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia was correlated with vancomycin susceptibility of the corresponding strains.（本研究的目的在于讨论MRSA菌血症患者德临床效果是否与金葡菌对万古霉素的敏感性相关。）

Methods（方法）
A retrospective study on MRSA bacteraemia was performed at a teaching hospital between January 1998 and October 2005 by linking vancomycin susceptibility profiles of patients' isolates with hospitalization data.（从1998年1月至2005年10月对一所教学医院的MRSA菌血症的患者进行回顾性研究，结合万古霉素的药敏数据和病历分析。）

Results（结果）
A total of 20 out of 209 MRSA bacteraemia patients were treated with vancomycin for at least 5 days with adequate trough levels, and fulfilled the study's inclusion and exclusion criteria. （按照研究设定的纳入和排除标准，在209个MRSA菌血症患者中，总计有20例使用足够剂量的万古霉素治疗至少5天。）Twenty-two S. aureus isolates from these patients' blood cultures were identified as MRSA, （从病人血培养中分离出22株金葡菌经鉴定为MRSA.）including two hetero-VISA from separate patients and two VISA with vancomycin MIC of 4 mg/L from one patient. (包括2株来自不同病人的异质性VISA和2株来自同一病人且万古霉素MIC=4mg/l的VISA.) Between patients who showed 'good' vancomycin response and patients who did not, there was a significant difference (p < 0.01) in their corresponding MRSAs' vancomycin susceptibility expressed by 'area under curve' (AUC) of population analysis. (比较对万古霉素效果“好”和不好的患者，MRSA对万古霉素的敏感性有显著性差异，表现为AUC曲线不同。)Significant correlations were found between AUC and initial vancomycin therapeutic response parameters of 'days till afebrile' (r = 0.828, p < 0.01) and 'days till CRP ≦ 30% of maximum' (r = 0.627, p < 0.01)（显著性相关也出现在AUC和初期的万古霉素治疗反应参数之间。）

Conclusion（结论）
Our study results caution healthcare personnel that early consideration should be given to cases with a poor vancomycin treatment response that could signify the involvement of MRSA with reduced susceptibility to vancomycin.（我们的研究结果提醒医护人员应该尽可能早期关注那些万古霉素敏感性下降且对万古霉素治疗反应差的病人。）

巴斯德之徒

日本是发现了VISA的哦!要小心了,他离我们太近了!
呵呵........;P ;P