Rupp M E, Archer G L
Department of Internal Medicine, University of Nebraska Medical Center, Omaha.
Clin Infect Dis. 1994 Aug;19(2):231-43; quiz 244-5. doi: 10.1093/clinids/19.2.231.
Coagulase-negative staphylococcal bacteremia and infections of prosthetic medical devices have become major clinical problems. Efforts to differentiate contaminating from infecting isolates consume the time of microbiology laboratory personnel; decisions over when and with what to institute therapy for multiresistant isolates consume the energy of clinicians; and the need to institute expensive parenteral antimicrobial therapy consumes the hospital pharmacy budget. It is clear that the increased incidence of coagulase-negative staphylococcal infections is the result of medical progress and is due to the use of invasive and indwelling medical devices. Multiresistant organisms have evolved that will survive in the presence of antimicrobial agents designed to eradicate more traditional pathogens. They have an ecological niche on human skin from which they are difficult to eradicate, and they have adapted themselves to survive on inert devices designed to persist indefinitely in the human body. Since it is likely that the use of prosthetic medical devices will continue to increase, we need to device innovative strategies for the diagnosis, treatment, and prevention of infections of these indwelling foreign bodies. Studies that will address these issues should be a major goal of future research on hospital-acquired infections.
凝固酶阴性葡萄球菌菌血症及人工医用装置感染已成为主要的临床问题。区分污染菌与感染菌分离株的工作耗费了微生物实验室人员的时间；对于多重耐药分离株何时以及采用何种治疗方法的决策耗费了临床医生的精力；而开展昂贵的肠外抗菌治疗的需求则耗费了医院药房的预算。显然，凝固酶阴性葡萄球菌感染发病率的增加是医学进步的结果，并且归因于侵入性和留置医用装置的使用。已出现了多重耐药菌，它们能在旨在根除更传统病原体的抗菌药物存在的情况下存活。它们在人类皮肤上有一个生态位，难以从中根除，并且它们已适应在旨在在人体中长期留存的惰性装置上存活。由于人工医用装置的使用可能会持续增加，我们需要制定创新策略来诊断、治疗和预防这些留置异物的感染。解决这些问题的研究应成为未来医院获得性感染研究的主要目标。
