2nd Infectious Diseases Division, National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
Postgrad Med. 2010 Nov;122(6):16-23. doi: 10.3810/pgm.2010.11.2218.
Methicillin-resistant Staphylococcus aureus (MRSA), one of the most common causes of infections, has been traditionally recognized as a nosocomial pathogen. However, in recent years, its epidemiology has radically changed, being now observed even more frequently in the community, and accounting for > 50% of staphylococcal infections in the US outpatient setting. Community-acquired (CA)-MRSA strains typically cause infections among otherwise healthy individuals, with risk factors differing from those of nosocomial MRSA. The clinical manifestations may range from a furuncle to life-threatening infections, such as necrotizing fasciitis and pneumonia. The antibiotic treatment of these infections may also differ because CA-MRSA strains often retain susceptibility to antimicrobials other than glycopeptides and newer agents. Moreover, the production of toxins, such as the Panton-Valentine leukocidin (PVL), should influence the antibiotic choice because in these cases the use of a combination therapy with antimicrobial agents able to decrease toxin production is suggested. There are still many unanswered key questions regarding the epidemiology, prevention, and treatment of CA-MRSA infections. This article reviews current knowledge of CA-MRSA.
耐甲氧西林金黄色葡萄球菌（MRSA）是最常见的感染原因之一，传统上被认为是医院病原体。然而，近年来，其流行病学发生了根本性变化，现在甚至在社区中更为常见，并且占美国门诊环境中葡萄球菌感染的>50％。社区获得性（CA）-MRSA 菌株通常在其他健康个体中引起感染，其危险因素与医院获得性 MRSA 不同。临床表现范围从疖到威胁生命的感染，如坏死性筋膜炎和肺炎。这些感染的抗生素治疗也可能有所不同，因为 CA-MRSA 菌株通常对除糖肽类和新型药物以外的抗生素保持敏感性。此外，毒素的产生，如潘顿-瓦伦丁白细胞毒素（PVL），应影响抗生素的选择，因为在这些情况下，建议使用能够减少毒素产生的抗生素联合治疗。关于 CA-MRSA 感染的流行病学、预防和治疗，仍有许多悬而未决的关键问题。本文综述了 CA-MRSA 的最新知识。
