08年6月CID关于MRSA感染的增刊打包下载

David

Clinical Infectious Diseases 2008;46:S344–S349

SUPPLEMENT ARTICLE
Epidemiology of Methicillin-Resistant Staphylococcus aureus
MRSA的流行病学
Helen W. Boucher1 and
G. Ralph Corey2

1Division of Infectious Diseases, Tufts University Medical School and New England Medical Center, Boston, Massachussetts; and 2Division of Infectious Diseases, Duke University Medical School and Duke Clinical Research Institute, Durham, North Carolina

The frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections continues to grow in hospital-associated settings and, more recently, in community settings in the United States and globally. The increase in the incidence of infections due to S. aureus is partially a consequence of advances in patient care and also of the pathogen’s ability to adapt to a changing environment. Infection due to S. aureus imposes a high and increasing burden on health care resources. A growing concern is the emergence of MRSA infections in patients with no apparent risk factors. MRSA infection in community settings involves considerable morbidity and mortality, as does nosocomial MRSA infection. For community-associated MRSA, person-to-person transmission has been reported, and several factors have been shown to predict disease. We examine the trends in both nosocomial and community-associated MRSA infections and explore recent studies of the mechanisms that allow S. aureus to become resistant to currently available drugs.

Clinical Infectious Diseases 2008;46:S350–S359

SUPPLEMENT ARTICLE
Pathogenesis of Methicillin-Resistant Staphylococcus aureus Infection
MRSA感染的致病机理
Rachel J. Gordon1 and
Franklin D. Lowy1,2

1Division of Infectious Diseases, Department of Medicine, and 2Department of Pathology, Columbia University College of Physicians and Surgeons, New York, New York

Staphylococcus aureus is a versatile pathogen capable of causing a wide range of human diseases. However, the role of different virulence factors in the development of staphylococcal infections remains incompletely understood. Some clonal types are well equipped to cause disease across the globe, whereas others are facile at causing disease among community members. In this review, general aspects of staphylococcal pathogenesis are addressed, with emphasis on methicillin-resistant strains. Although methicillin-resistant S. aureus (MRSA) strains are not necessarily more virulent than methicillin-sensitive S. aureus strains, some MRSA strains contain factors or genetic backgrounds that may enhance their virulence or may enable them to cause particular clinical syndromes. We examine these pathogenic factors.


Clinical Infectious Diseases 2008;46:S360–S367

SUPPLEMENT ARTICLE
Increasing Antibiotic Resistance among Methicillin-Resistant Staphylococcus aureus Strains
MRSA日益严重的耐药性
George Sakoulas1 and
Robert C. Moellering, Jr.2

1Division of Infectious Diseases, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York; and 2Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachussetts

Vancomycin use has increased dramatically worldwide since the mid-1980s, largely as a result of empirical and directed therapy against burgeoning methicillin-resistant Staphylococcus aureus (MRSA) infections. With limited choices, clinicians have traditionally relied on vancomycin alone in the management of serious MRSA infections and have enjoyed a significant period free of vancomycin resistance in S. aureus. Even now, 5 decades after its introduction, vancomycin resistance among S. aureus strains, as currently defined microbiologically, remains rare. Yet it is becoming clear that vancomycin is losing potency against S. aureus, including MRSA. Serious infections due to MRSA defined as susceptible in the laboratory are not responding well to vancomycin. This is demonstrated by increased mortality seen in patients with MRSA infection and markedly attenuated vancomycin efficacy caused by vancomycin heteroresistance in S. aureus. Therefore, it appears that our definition of vancomycin susceptibility requires further scrutiny as applied to serious MRSA infections, such as bacteremia and pneumonia.

Clinical Infectious Diseases 2008;46:S368–S377

SUPPLEMENT ARTICLE
Skin and Soft-Tissue Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus
社区获得性MRSA导致的皮肤和软组织感染
Martin E. Stryjewski1,2 and
Henry F. Chambers3

1Duke Clinical Research Institute, Durham, North Carolina; 2Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina; and 3Division of Infectious Diseases, University of California–San Francisco, San Francisco

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection has become epidemic. Skin and soft-tissue infections (SSTIs) are the most frequent forms of the disease. Obtainment of culture specimens is important for documentation of the presence of MRSA and for susceptibility testing to guide therapy. Purulent lesions should be drained whenever possible. In areas where community-acquired MRSA isolates are prevalent, uncomplicated SSTI in healthy individuals may be treated empirically with clindamycin, trimethoprim-sulfamethoxazole, or long-acting tetracyclines, although specific data supporting the efficacy of these treatments are lacking. In healthy patients with small purulent lesions, drainage alone may be sufficient. In patients with complicated SSTI requiring hospitalization or intravenous therapy, vancomycin is the drug of choice because of the low cost, efficacy, and safety. Linezolid, daptomycin, and tigecycline are also effective, although published studies on the last 2 agents for the treatment of SSTI due to MRSA are more limited. Dalbavancin, telavancin, and ceftobiprole are investigational agents that may expand our therapeutic options for the treatment of SSTI caused by MRSA.

Clinical Infectious Diseases 2008;46:S378–S385

SUPPLEMENT ARTICLE
Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus
MRSA引起的肺炎
Ethan Rubinstein,1
Marin H. Kollef,2 and
Dilip Nathwani3

1University of Manitoba, Winnipeg, Canada; 2Washington University School of Medicine, St. Louis, Missouri; and 3Ninewells Hospital and Medical School, Dundee, Scotland

A recent increase in staphylococcal infections caused by methicillin-resistant Staphylococcus aureus (MRSA), combined with frequent, prolonged ventilatory support of an aging, often chronically ill population, has resulted in a large increase in cases of MRSA pneumonia in the health care setting. In addition, community-acquired MRSA pneumonia has become more prevalent. This type of pneumonia historically affects younger patients, follows infection with influenza virus, and is often severe, requiring hospitalization and causing the death of a significant proportion of those affected. Ultimately, hospital-acquired MRSA and community-acquired MRSA are important causes of pneumonia and present diagnostic and therapeutic challenges. Rapid institution of appropriate antibiotic therapy, including linezolid as an alternative to vancomycin, is crucial. Respiratory infection–control measures and de-escalation of initial broad-spectrum antibiotic regimens to avoid emergence of resistant organisms are also important. This article reviews the clinical features of, diagnosis of, and therapies for MRSA pneumonia.

Clinical Infectious Diseases 2008;46:S386–S393

SUPPLEMENT ARTICLE
Management of Methicillin-Resistant Staphylococcus aureus Bacteremia
管理控制MRSA菌血症
Sara E. Cosgrove1 and
Vance G. Fowler, Jr.2

1Johns Hopkins University School of Medicine, Baltimore, Maryland; and 2Duke University Medical Center, Durham, North Carolina

Staphylococcus aureus bacteremia and endocarditis are serious infections that demand prompt clinical attention to ensure good outcomes. Of foremost importance is identifying and managing the source of infection and any associated complications. Evaluation for the presence of cardiac involvement is essential because inadequately managed S. aureus endocarditis is life threatening. Thus, physicians must aggressively negotiate treatment paths, considering whether the S. aureus bacteremia is complicated, whether foreign sources of infection should be removed or replaced, and whether surgical intervention is necessary. Selection of an antibiotic treatment is also an essential factor for optimal management. The increasing prevalence of methicillin-resistant S. aureus (MRSA) infections has created a tremendous demand for effective and safe antimicrobial agents other than the historic anti-MRSA agent vancomycin.

[ 本帖最后由 David 于 2008-5-9 14:40 编辑 ]

绿茵场

very delicious! thank David!:handshake

宁静致远

谢谢David版主,辛苦了!
期待经常看到新的指南或文献,帮助我们紧跟国际最新进展.:handshake :handshake

朱德权

谢谢提供外文资料，及时学习

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