McKinnon Peggy S, Boening Amanda J, Amin Alpesh N
University of California-Irvine, Orange, CA 92868, USA.
Hosp Pract (1995). 2011 Apr;39(2):18-31. doi: 10.3810/hp.2011.04.391.
Staphylococcus aureus is among the most prevalent pathogens isolated from hospitalized patients; those infected with methicillin-resistant strains have longer hospital stays and higher total costs compared with those infected by methicillin-susceptible strains. A multidisciplinary team of health care providers, including hospitalists and other hospital-based physicians, clinical pharmacists, infectious disease specialists, infection control professionals, and case managers, is key to improving treatment and outcomes in these patients. Optimizing transitions of care for hospitalized patients with S aureus infections can improve quality and reduce total costs of care. Hospital length of stay can be shortened by initiating timely, appropriate empiric therapy and by transitioning suitable patients to outpatient antimicrobial therapy. The number of hospitalizations can be reduced by identifying patients who are suitable candidates for initial outpatient antimicrobial therapy. Consistent with good antimicrobial stewardship, the risk of resistance can be minimized by de-escalating empiric therapy to a more narrow-spectrum agent once culture and susceptibility testing results are known. There are several antimicrobial agents available for the management of S aureus infections, including methicillin-resistant S aureus. Consideration of these agents' characteristics may facilitate optimal transition of patients through health care settings.
金黄色葡萄球菌是从住院患者中分离出的最常见病原体之一；与感染甲氧西林敏感菌株的患者相比，感染耐甲氧西林菌株的患者住院时间更长，总费用更高。包括住院医师和其他医院医生、临床药剂师、传染病专家、感染控制专业人员和病例管理人员在内的多学科医疗团队，对于改善这些患者的治疗和预后至关重要。优化金黄色葡萄球菌感染住院患者的护理转接可以提高护理质量并降低护理总成本。通过及时启动适当的经验性治疗以及将合适的患者转为门诊抗菌治疗，可以缩短住院时间。通过识别适合初始门诊抗菌治疗的患者，可以减少住院次数。与良好的抗菌药物管理相一致，一旦获得培养和药敏试验结果，通过将经验性治疗降级为更窄谱的药物，可以将耐药风险降至最低。有几种抗菌药物可用于治疗金黄色葡萄球菌感染，包括耐甲氧西林金黄色葡萄球菌感染。考虑这些药物的特性可能有助于患者在不同医疗机构间实现最佳转接。
