【柳叶刀】金黄色葡萄球菌菌血症的临床管理(2011)

蓝鱼o_0

Lancet Infect Dis 2011;11: 208–22
【Abstract】
Staphylococcus aureus bacteraemia is one of the most common serious bacterial infections worldwide. In the UK alone, around 12 500 cases each year are reported, with an associated mortality of about 30%, yet the evidence guiding optimum management is poor. To date, fewer than 1500 patients with S aureus bacteraemia have been recruited to 16 controlled trials of antimicrobial therapy. Consequently, clinical practice is driven by the results of observational studies and anecdote. Here, we propose and review ten unanswered clinical questions commonly posed by those managing S aureus bacteraemia. Our findings defi ne the major areas of uncertainty in the management of S aureus bacteraemia and highlight just two key principles. First, all infective foci must be identified and removed as soon as possible. Second, long-term antimicrobial therapy is required for those with persistent bacteraemia or a deep,
irremovable focus. Beyond this, the best drugs, dose, mode of delivery, and duration of therapy are uncertain, a situation compounded by emerging S aureus strains that are resistant to old and new antibiotics. We discuss the consequences on clinical practice, and how these findings define the agenda for future clinical research.

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快译摘要如下:
金黄色葡萄球菌菌血症（SAB）是世界上最常见的细菌感染的情况。就英国而言，每年月有12500名病例，死亡率约30%。但是对于SAB管理的最优的管理指南目前尚显不足。到目前为止，16个前瞻性抗生素治疗临床随机对照试验，才纳入了不到1500名SAB病例。结果，这些研究结果和观察性研究指导了目前的临床操作。在本次研究中，我们通过提出和综述了10个临床上管理SAB感染种的问题。
首先，所有的感染点必须尽快确诊和清除。第二，对于长期存在的菌血症感染，或者深部感染不能清除者，长期的抗生素治疗是必要的。除此之外，最好的药物、剂量、分娩方式，治疗时间等尚不确定。新出现的金黄色葡萄球菌菌株对现存在或者新研发的抗生素存在抗性也使得情况更为复杂。在此，我们讨论临床操作的结果，并探讨研究结果对未来临床研究发展走向有怎样的影响。