经验性门诊治疗蜂窝织炎，可选择使用复方磺胺甲噁唑、头孢氨苄或克林霉素。
Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for cellulitis.
机构信息
Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
出版信息
Am J Med. 2010 Oct;123(10):942-50. doi: 10.1016/j.amjmed.2010.05.020.
BACKGROUND
Limited data exist on optimal empiric oral antibiotic treatment for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections.
METHODS
We conducted a 3-year retrospective cohort study of outpatients with cellulitis empirically treated at a teaching clinic of a tertiary-care medical center in Hawaii. Patients who received more than 1 oral antibiotic, were hospitalized, or had no follow-up information were excluded. Treatment success rates for empiric therapy were compared among commonly prescribed antibiotics in our clinic: cephalexin, trimethoprim-sulfamethoxazole, and clindamycin. Risk factors for treatment failure were evaluated using multivariate logistic regression analysis.
RESULTS
Of 544 patients with cellulitis, 405 met the inclusion criteria. The overall treatment success rate of trimethoprim-sulfamethoxazole was significantly higher than the rate of cephalexin (91% vs 74%; P<.001), whereas clindamycin success rates were higher than those of cephalexin in patients who had subsequently culture-confirmed MRSA infections (P=.01), had moderately severe cellulitis (P=.03), and were obese (P=.04). Methicillin-resistant S. aureus was recovered in 72 of 117 positive culture specimens (62%). Compliance and adverse drug reaction rates were not significantly different among patients who received these 3 antibiotics. Factors associated with treatment failure included therapy with an antibiotic that was not active against community-associated MRSA (adjusted odds ratio 4.22; 95% confidence interval, 2.25-7.92; P<.001) and severity of cellulitis (adjusted odds ratio 3.74; 95% confidence interval, 2.06-6.79; P<.001).
CONCLUSION
Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting.
背景
在社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染高发地区，对于门诊蜂窝织炎患者，经验性口服抗生素治疗的最佳选择有限。
方法
我们对在夏威夷一家三级医疗中心的教学诊所接受经验性治疗的门诊蜂窝织炎患者进行了一项为期 3 年的回顾性队列研究。排除了接受超过 1 种口服抗生素、住院或无随访信息的患者。在我们的诊所中，比较了常用抗生素（头孢氨苄、复方磺胺甲噁唑和克林霉素）的经验性治疗成功率。使用多变量逻辑回归分析评估治疗失败的风险因素。
结果
在 544 例蜂窝织炎患者中，405 例符合纳入标准。复方磺胺甲噁唑的总体治疗成功率明显高于头孢氨苄（91%比 74%；P<.001），而克林霉素的成功率在随后培养出 CA-MRSA 感染的患者中高于头孢氨苄（P=.01），在中度严重蜂窝织炎患者中（P=.03）和肥胖患者中（P=.04）。在 117 份阳性培养标本中，有 72 份（62%）分离出耐甲氧西林金黄色葡萄球菌。接受这 3 种抗生素治疗的患者的药物依从性和药物不良反应发生率无显著差异。与治疗失败相关的因素包括使用对 CA-MRSA 无效的抗生素治疗（调整后的优势比 4.22；95%置信区间，2.25-7.92；P<.001）和蜂窝织炎严重程度（调整后的优势比 3.74；95%置信区间，2.06-6.79；P<.001）。
结论
在 CA-MRSA 高发地区，对于门诊蜂窝织炎患者，具有抗 CA-MRSA 活性的抗生素，如复方磺胺甲噁唑和克林霉素，是经验性治疗的首选。
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