耐甲氧西林金黄色葡萄球菌菌血症持续存在：重置时钟以优化管理。
Persistent Methicilin-Resistant Staphylococcus aureus Bacteremia: Resetting the Clock for Optimal Management.
机构信息
Department of Medicine, Duke University, Durham, North Carolina, USA.
Duke Clinical Research Institute, Durham, North Carolina, USA.
出版信息
Clin Infect Dis. 2022 Oct 29;75(9):1668-1674. doi: 10.1093/cid/ciac364.
Abstract
A positive follow-up blood culture for methicillin-resistant Staphylococcus aureus (MRSA) while on seemingly appropriate therapy is a common and ominous development. However, the definition and management of persistent MRSA bacteremia is unstandardized. In this Opinion Paper, we identify the presence of bacteremia for > 1 calendar day as a "worry point" that should trigger an intensive diagnostic evaluation to identify metastatic infection sites. Next, we define the duration of MRSA bacteremia that likely constitutes antibiotic failure and outline a potential management algorithm for such patients. Finally, we propose pragmatic clinical trial designs to test treatment strategies for persistent MRSA bacteremia.
摘要
在看似适当的治疗过程中，耐甲氧西林金黄色葡萄球菌 (MRSA) 的血培养呈阳性，这是一种常见且危险的情况。然而，持续性 MRSA 菌血症的定义和管理尚未标准化。在本观点文章中，我们将血培养阳性持续>1 个日历日定义为“关注点”，这应该触发强化诊断评估以确定转移性感染部位。接下来，我们定义了可能构成抗生素治疗失败的 MRSA 菌血症持续时间，并概述了此类患者的潜在管理算法。最后，我们提出了实用的临床试验设计，以测试持续性 MRSA 菌血症的治疗策略。
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