Sakoulas George, Moellering Robert C
Division of Infectious Diseases, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.
Clin Infect Dis. 2008 Jun 1;46 Suppl 5:S360-7. doi: 10.1086/533592.
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.
自20世纪80年代中期以来，万古霉素在全球范围内的使用量急剧增加，这主要是由于针对迅速增多的耐甲氧西林金黄色葡萄球菌（MRSA）感染进行经验性和针对性治疗的结果。由于选择有限，临床医生传统上在严重MRSA感染的治疗中仅依赖万古霉素，并且在相当长的一段时间内金黄色葡萄球菌未出现万古霉素耐药情况。即使在其引入后的50年，按照目前微生物学定义，金黄色葡萄球菌菌株中的万古霉素耐药性仍然罕见。然而，越来越明显的是，万古霉素对包括MRSA在内的金黄色葡萄球菌的效力正在下降。实验室定义为敏感的MRSA引起的严重感染对万古霉素反应不佳。这在MRSA感染患者中观察到的死亡率增加以及金黄色葡萄球菌中万古霉素异质性耐药导致的万古霉素疗效明显减弱中得到了体现。因此，对于严重的MRSA感染，如菌血症和肺炎，我们应用于万古霉素敏感性的定义似乎需要进一步审查。
