Centre for Molecular Microbiology and Infection, Imperial College, London, UK.
Lancet Infect Dis. 2011 Mar;11(3):208-22. doi: 10.1016/S1473-3099(10)70285-1.
Staphylococcus aureus bacteraemia is one of the most common serious bacterial infections worldwide. In the UK alone, around 12,500 cases each year are reported, with an associated mortality of about 30%, yet the evidence guiding optimum management is poor. To date, fewer than 1500 patients with S aureus bacteraemia have been recruited to 16 controlled trials of antimicrobial therapy. Consequently, clinical practice is driven by the results of observational studies and anecdote. Here, we propose and review ten unanswered clinical questions commonly posed by those managing S aureus bacteraemia. Our findings define the major areas of uncertainty in the management of S aureus bacteraemia and highlight just two key principles. First, all infective foci must be identified and removed as soon as possible. Second, long-term antimicrobial therapy is required for those with persistent bacteraemia or a deep, irremovable focus. Beyond this, the best drugs, dose, mode of delivery, and duration of therapy are uncertain, a situation compounded by emerging S aureus strains that are resistant to old and new antibiotics. We discuss the consequences on clinical practice, and how these findings define the agenda for future clinical research.
金黄色葡萄球菌菌血症是全球最常见的严重细菌感染之一。仅在英国，每年就报告约 12500 例病例，死亡率约为 30%，但指导最佳管理的证据却很少。迄今为止，只有不到 1500 例金黄色葡萄球菌菌血症患者被纳入了 16 项抗菌治疗的对照试验。因此，临床实践主要受到观察性研究和传闻的影响。在这里，我们提出并回顾了管理金黄色葡萄球菌菌血症时常见的十个未解答的临床问题。我们的发现确定了金黄色葡萄球菌菌血症管理中存在的主要不确定性领域，并仅强调了两个关键原则。首先，必须尽快识别和去除所有感染病灶。其次，对于持续性菌血症或深部、不可去除病灶的患者，需要长期使用抗菌药物。除此之外，最佳药物、剂量、给药方式和治疗持续时间尚不确定，而新出现的对旧抗生素和新抗生素均具有耐药性的金黄色葡萄球菌菌株使情况更加复杂。我们讨论了这些发现对临床实践的影响，以及这些发现如何为未来的临床研究制定议程。
