Nathwani Dilip, Davey Peter Garnet, Marwick Charis Ann
Ninewells Hospital & Medical School, Dundee, UK.
BMJ Clin Evid. 2010 Oct 28;2010:0922.
Methicillin-resistant Staphylococcus aureus (MRSA) has a gene that makes it resistant to methicillin as well as to other beta-lactam antibiotics including flucloxacillin, beta-lactam/beta-lactamase inhibitor combinations, cephalosporins, and carbapenems. MRSA can be part of the normal body flora (colonisation), especially in the nose, but it can cause infection, especially in people with prolonged hospital admissions, with underlying disease, or after antibiotic use. About 20% of S aureus in blood cultures in England, Wales, and Northern Ireland is resistant to methicillin.
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatment for MRSA infections at any body site? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 11 systematic reviews, RCTs, or observational studies that met our inclusion criteria.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: clindamycin, daptomycin, fusidic acid, glycopeptides (teicoplanin, vancomycin), linezolid, macrolides (azithromycin, clarithromycin, erythromycin), quinolones (ciprofloxacin, levofloxacin, moxifloxacin), quinupristin-dalfopristin, pristinamycin, rifampicin, tetracyclines (doxycycline, minocycline, oxytetracycline), tigecycline, trimethoprim, and trimethoprim-sulfamethoxazole (co-trimoxazole).
耐甲氧西林金黄色葡萄球菌（MRSA）有一个使其对甲氧西林以及其他β-内酰胺类抗生素耐药的基因，这些抗生素包括氟氯西林、β-内酰胺/β-内酰胺酶抑制剂复方制剂、头孢菌素和碳青霉烯类。MRSA可以是人体正常菌群的一部分（定植），尤其是在鼻腔，但它可引起感染，特别是在住院时间延长、有基础疾病或使用抗生素后的人群中。在英格兰、威尔士和北爱尔兰，血液培养中约20%的金黄色葡萄球菌对甲氧西林耐药。
我们进行了一项系统评价，旨在回答以下临床问题：对任何身体部位的MRSA感染进行治疗的效果如何？我们检索了：截至2009年11月的Medline、Embase、Cochrane图书馆及其他重要数据库（临床证据综述会定期更新，请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品与保健品监管局（MHRA）等相关组织的危害警示。
我们发现了11项符合我们纳入标准的系统评价、随机对照试验或观察性研究。
在本系统评价中，我们呈现了以下干预措施有效性和安全性的相关信息：克林霉素、达托霉素、夫西地酸、糖肽类（替考拉宁、万古霉素）、利奈唑胺、大环内酯类（阿奇霉素、克拉霉素、红霉素）、喹诺酮类（环丙沙星、左氧氟沙星、莫西沙星）、奎奴普丁-达福普汀、利福霉素、利福平、四环素类（多西环素、米诺环素、土霉素）、替加环素、甲氧苄啶以及甲氧苄啶-磺胺甲恶唑（复方新诺明）。
