Departments of Medicine, Pediatrics, and Public Health Sciences, The University of Chicago, 5841 S. Maryland Ave., MC6054, Chicago, IL, 60637, USA.
Department of Medicine, University of Pennsylvania, 423 Guardian Drive, 930 Blockley Hall, Philadelphia, PA, 19104, USA.
Curr Top Microbiol Immunol. 2017;409:325-383. doi: 10.1007/82_2017_42.
Staphylococcus aureus, although generally identified as a commensal, is also a common cause of human bacterial infections, including of the skin and other soft tissues, bones, bloodstream, and respiratory tract. The history of S. aureus treatment is marked by the development of resistance to each new class of antistaphylococcal antimicrobial drugs, including the penicillins, sulfonamides, tetracyclines, glycopeptides, and others, complicating therapy. S. aureus isolates identified in the 1960s were sometimes resistant to methicillin, a ß-lactam antimicrobial active initially against a majority S. aureus strains. These MRSA isolates, resistant to nearly all ß-lactam antimicrobials, were first largely confined to the health care environment and the patients who attended it. However, in the mid-1990s, new strains, known as community-associated (CA-) MRSA strains, emerged. CA-MRSA organisms, compared with health care-associated (HA-) MRSA strain types, are more often susceptible to multiple classes of non ß-lactam antimicrobials. While infections caused by methicillin-susceptible S. aureus (MSSA) strains are usually treated with drugs in the ß-lactam class, such as cephalosporins, oxacillin or nafcillin, MRSA infections are treated with drugs in other antimicrobial classes. The glycopeptide drug vancomycin, and in some countries teicoplanin, is the most common drug used to treat severe MRSA infections. There are now other classes of antimicrobials available to treat staphylococcal infections, including several that have been approved after 2009. The antimicrobial management of invasive and noninvasive S. aureus infections in the ambulatory and in-patient settings is the topic of this review. Also discussed are common adverse effects of antistaphylococcal antimicrobial agents, advantages of one agent over another for specific clinical syndromes, and the use of adjunctive therapies such as surgery and intravenous immunoglobulin. We have detailed considerations in the therapy of noninvasive and invasive S. aureus infections. This is followed by sections on specific clinical infectious syndromes including skin and soft tissue infections, bacteremia, endocarditis and intravascular infections, pneumonia, osteomyelitis and vertebral discitis, epidural abscess, septic arthritis, pyomyositis, mastitis, necrotizing fasciitis, orbital infections, endophthalmitis, parotitis, staphylococcal toxinoses, urogenital infections, and central nervous system infections.
金黄色葡萄球菌虽然通常被认为是一种共生菌，但也是人类细菌感染的常见原因，包括皮肤和其他软组织、骨骼、血液和呼吸道感染。金黄色葡萄球菌治疗的历史特点是对每一种新的抗葡萄球菌抗菌药物的耐药性的发展，包括青霉素、磺胺类药物、四环素类、糖肽类和其他药物，使治疗变得复杂。20 世纪 60 年代分离的金黄色葡萄球菌株有时对甲氧西林耐药，甲氧西林是一种最初对大多数金黄色葡萄球菌菌株有效的β-内酰胺类抗菌药物。这些耐甲氧西林金黄色葡萄球菌（MRSA）分离株几乎对所有β-内酰胺类抗菌药物均耐药，最初主要局限于医疗保健环境和就诊患者中。然而，在 20 世纪 90 年代中期，出现了新的菌株，称为社区相关性（CA）MRSA 菌株。与医源性相关（HA）MRSA 株型相比，CA-MRSA 菌更容易对多种非β-内酰胺类抗菌药物敏感。虽然耐甲氧西林金黄色葡萄球菌（MSSA）菌株引起的感染通常用β-内酰胺类药物治疗，如头孢菌素、头孢唑啉或萘夫西林，但耐甲氧西林金黄色葡萄球菌感染用其他抗菌药物类药物治疗。糖肽类药物万古霉素，在一些国家用替考拉宁，是治疗严重耐甲氧西林金黄色葡萄球菌感染最常用的药物。现在有其他类别的抗菌药物可用于治疗葡萄球菌感染，包括 2009 年后批准的几种药物。本文综述了门诊和住院患者侵袭性和非侵袭性金黄色葡萄球菌感染的抗菌管理。还讨论了抗葡萄球菌抗菌药物的常见不良反应、一种药物相对于另一种药物在特定临床综合征中的优势，以及手术和静脉注射免疫球蛋白等辅助治疗的应用。我们详细考虑了非侵袭性和侵袭性金黄色葡萄球菌感染的治疗。接下来是关于特定临床感染综合征的章节，包括皮肤和软组织感染、菌血症、心内膜炎和血管内感染、肺炎、骨髓炎和椎间盘炎、硬膜外脓肿、化脓性关节炎、肌脓肿、乳腺炎、坏死性筋膜炎、眶内感染、眼内炎、腮腺炎、葡萄球菌毒素血症、泌尿生殖道感染和中枢神经系统感染。
