Department of Clinical Microbiology, Sandringham Building, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
J Antimicrob Chemother. 2010 Feb;65(2):347-9. doi: 10.1093/jac/dkp456. Epub 2009 Dec 15.
Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) in the UK are common and associated with significant morbidity and mortality. Vancomycin is the usual first-line therapy. However, vancomycin treatment of BSIs due to MRSA strains with vancomycin MICs of 1-2 mg/L is successful in <10% of cases. No consensus exists on when to use newer agents, particularly when vancomycin MICs are >1 mg/L. We therefore surveyed UK practices of the management of MRSA BSIs due to isolates with increased vancomycin MICs.
Five hundred and seventy-one UK consultant microbiologists were contacted via e-mail and asked to take part in an online survey, hosted at www.surveymonkey.com. Responses were collated by the website, downloaded and analysed in a Microsoft Excel (Microsoft Corporation) spreadsheet.
One hundred and eight respondents participated in the survey. Only 32.7% routinely measure MICs, mostly by Etest. Forty-two percent use vancomycin alone for removable-focus infections, whilst for infections of cardiac or orthopaedic origin, 49% would add rifampicin. Few respondents use daptomycin, linezolid or tigecycline empirically. Sixty-nine percent would use linezolid as a second-line agent, with only 19% opting for daptomycin. For an isolate with a vancomycin MIC of 4 mg/L, respondents would use daptomycin (81%) or linezolid (91%) in patients with a poor clinical response.
Vancomycin is the mainstay therapy for MRSA BSIs, even when MICs are not measured or raised, despite evidence of high failure rates. The use of newer agents frequently does not follow European or US licensed indications, may be inappropriate and may result in avoidable deaths.
耐甲氧西林金黄色葡萄球菌（MRSA）血流感染（BSI）在英国很常见，与显著的发病率和死亡率相关。万古霉素是常用的一线治疗药物。然而，对于万古霉素 MIC 为 1-2mg/L 的 MRSA 菌株引起的 BSI，万古霉素治疗的成功率<10%。对于何时使用新的药物，特别是当万古霉素 MIC>1mg/L 时，尚无共识。因此，我们调查了英国对由于万古霉素 MIC 增加的分离株引起的 MRSA BSI 的管理实践。
通过电子邮件联系了 571 名英国顾问微生物学家，请他们参加在 www.surveymonkey.com 上进行的在线调查。网站收集了回复，并将其下载并在 Microsoft Excel（Microsoft Corporation）电子表格中进行分析。
有 108 名受访者参与了调查。只有 32.7%的人常规测量 MIC，主要通过 Etest 测量。42%的人仅对可移除焦点感染使用万古霉素单独治疗，而对于心脏或骨科来源的感染，49%的人会添加利福平。很少有受访者经验性地使用达托霉素、利奈唑胺或替加环素。69%的人将使用利奈唑胺作为二线药物，只有 19%的人选择达托霉素。对于万古霉素 MIC 为 4mg/L 的分离株，受访者会在患者临床反应不佳时使用达托霉素（81%）或利奈唑胺（91%）。
即使没有测量或升高 MIC，万古霉素仍是 MRSA BSI 的主要治疗药物，尽管有高失败率的证据。新药物的使用经常不符合欧洲或美国许可的适应症，可能不适当，并可能导致可避免的死亡。
