Wilsey H Andrew, Burgess Donna R, Burgess David S
Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA
University of Kentucky, UK HealthCare, Lexington, Kentucky, USA.
Antimicrob Agents Chemother. 2020 Jun 23;64(7). doi: 10.1128/AAC.00360-20.
Methicillin-resistant (MRSA) has grown to become a major burden on health care systems. The cumulation of limited therapeutic options and worsened patient outcomes with persistent MRSA bacteremia has driven research in optimizing its initial management. The guidelines published by the Infectious Diseases Society of America currently recommend combination therapy for refractory MRSA bacteremia, but the utility of combining antibiotics from the start of therapy is under investigation. The alternative strategy of early use of β-lactam antibiotics in combination with vancomycin upon initial MRSA bacteremia detection has shown promise. While this concept has gained international attention, providers should give this strategy serious consideration prior to implementation. The objective of this review is to examine retrospective and prospective evidence for early combination with vancomycin and β-lactam antibiotics, as well as explore potential consequences of combination therapy.
耐甲氧西林金黄色葡萄球菌（MRSA）已成为医疗保健系统的一大负担。有限的治疗选择以及持续性MRSA菌血症导致患者预后恶化，这促使人们开展研究以优化其初始治疗。美国传染病学会发布的指南目前推荐对难治性MRSA菌血症采用联合治疗，但从治疗开始就联合使用抗生素的效用仍在研究中。在首次检测到MRSA菌血症时早期使用β-内酰胺类抗生素联合万古霉素的替代策略已显示出前景。虽然这一概念已引起国际关注，但医疗服务提供者在实施该策略之前应认真考虑。本综述的目的是研究早期联合使用万古霉素和β-内酰胺类抗生素的回顾性和前瞻性证据，并探讨联合治疗的潜在后果。
