Srinivasan Arjun, Dick James D, Perl Trish M
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Clin Microbiol Rev. 2002 Jul;15(3):430-8. doi: 10.1128/CMR.15.3.430-438.2002.
Vancomycin resistance has been reported in clinical isolates of both coagulase-negative staphylococci and Staphylococcus aureus. The emerging threat of widespread vancomycin resistance poses a serious public health concern given the fact that vancomycin has long been the preferred treatment of antibiotic-resistant gram-positive organisms. Though major efforts are now being focused on improving our understanding of vancomycin resistance, there is much that remains unknown at this time. This article reviews the major epidemiologic, microbiologic, and clinical characteristics of vancomycin resistance in both coagulase-negative staphylococci and S. aureus. The review begins with a discussion of issues common to both coagulase-negative staphylococci and S. aureus, such as definitions, laboratory detection of vancomycin resistance, and infection control issues related to vancomycin-resistant staphylococci. The rest of the article is then devoted to a discussion of issues unique to each organism, including epidemiology, risk factors for infection, mechanisms of resistance, and management options.
在凝固酶阴性葡萄球菌和金黄色葡萄球菌的临床分离株中均已报道了对万古霉素的耐药性。鉴于万古霉素长期以来一直是治疗耐抗生素革兰氏阳性菌的首选药物，广泛存在的万古霉素耐药性这一新兴威胁引发了严重的公共卫生问题。尽管目前主要精力集中在增进我们对万古霉素耐药性的理解上，但目前仍有许多未知之处。本文综述了凝固酶阴性葡萄球菌和金黄色葡萄球菌中万古霉素耐药性的主要流行病学、微生物学和临床特征。综述首先讨论了凝固酶阴性葡萄球菌和金黄色葡萄球菌共有的问题，如定义、万古霉素耐药性的实验室检测以及与耐万古霉素葡萄球菌相关的感染控制问题。本文其余部分则专门讨论每种细菌特有的问题，包括流行病学、感染风险因素、耐药机制和管理选择。
