Lentino J R, Narita M, Yu V L
Section of Infectious Diseases, Loyola University Stritch School of Medicine, Edward Hines DVA Hospital, Hines DVA Medical Center, Division of Infectious Diseases, 2160 S First Ave, Maywood, IL 60153, USA.
Eur J Clin Microbiol Infect Dis. 2008 Jan;27(1):3-15. doi: 10.1007/s10096-007-0389-y.
Vancomycin- and methicillin-resistant gram-positive cocci have emerged as an increasingly problematic cause of hospital-acquired infections. We conducted a literature review of newer antibiotics with activity against vancomycin-resistant and methicillin-resistant gram-positive cocci. Quinupristin/dalfopristin, linezolid, daptomycin, and tigecycline have in vitro activity for methicillin-resistant staphylococci and are superior to vancomycin for vancomycin-resistant isolates. Dalbavancin, telavancin, and oritavancin are new glycopeptides that have superior pharmacodynamic properties compared to vancomycin. We review the antibacterial spectrum, clinical indications and contraindications, pharmacologic properties, and adverse events associated with each of these agents. Daptomycin has rapid bactericidal activity for Staphylococcus aureus and is approved for use in bacteremia and right-sided endocarditis. Linezolid is comparable to vancomycin in patients with methicillin-resistant S. aureus (MRSA) pneumonia and has pharmacoeconomic advantages given its oral formulation. Quinupristin/dalfopristin is the drug of choice for vancomycin-resistant Enterococcus faecium infections but has no activity against Enterococcus faecalis. Tigecycline has activity against both enterococcus species and MRSA; it is also active against Enterobacteriaceae and anaerobes which allows for use in intra-abdominal and diabetic foot infections. A review of numerous in vitro and animal model studies shows that interaction between these newer agents and other antistaphylococcal agents for S. aureus are usually indifferent (additive).
耐万古霉素和耐甲氧西林的革兰氏阳性球菌已成为医院获得性感染中一个日益棘手的病因。我们对具有抗耐万古霉素和耐甲氧西林革兰氏阳性球菌活性的新型抗生素进行了文献综述。奎奴普丁/达福普汀、利奈唑胺、达托霉素和替加环素对耐甲氧西林葡萄球菌具有体外活性，并且对于耐万古霉素菌株而言优于万古霉素。达巴万星、特拉万星和奥利万星是新型糖肽类药物，与万古霉素相比具有更优的药效学特性。我们综述了这些药物各自的抗菌谱、临床适应证和禁忌证、药理学特性以及相关不良事件。达托霉素对金黄色葡萄球菌具有快速杀菌活性，已获批用于治疗菌血症和右侧心内膜炎。在耐甲氧西林金黄色葡萄球菌（MRSA）肺炎患者中，利奈唑胺与万古霉素疗效相当，且因其口服剂型具有药物经济学优势。奎奴普丁/达福普汀是耐万古霉素粪肠球菌感染的首选药物，但对屎肠球菌无活性。替加环素对肠球菌属和MRSA均有活性；它对肠杆菌科细菌和厌氧菌也有活性，可用于治疗腹腔内感染和糖尿病足感染。对大量体外研究和动物模型研究的综述表明，这些新型药物与其他抗葡萄球菌药物对金黄色葡萄球菌的相互作用通常为无关作用（相加作用）。
