562 (Chin J New Drugs Clin Rem) ~ 1.25 L kg % ~ 1.37 ml kg -1 min : 30 mg L -1 90% 24 h : 2.

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1 (Chin J New Drugs Clin Rem) [ ] (2011) (2011 ) (vancomycin) g 10 ml 5% 0.9% 5 g L -1 (MRS) g L -1 1 h MRS < 10 mg min (1 ~ 30 ) 24 h mg L mg L MRS PK / PD ; 15 ~ 20 mg L -1 [1] ; g 1 h 63 mg L -1 2 h (MRSA) 23 mg L h 8 mg L g 30 min 49 mg L % % ~ 55% 1958 FDA 18% C 66 N 75 C 12 N ~ 4 mg L -1 ph3 ~ 5 B 6.4 ~ 11.1 mg L -1 [2] 95% < 4% mg d -1 9 d ~ 2 h 19 mg L -1 6 h 10 mg L mg L -1 [3]

2 562 (Chin J New Drugs Clin Rem) ~ 1.25 L kg % ~ 1.37 ml kg -1 min : 30 mg L -1 90% 24 h : (t 蚝虔 β) t 蚝虔 β 4 ~ 6 h [6] t 蚝虔 β 5 ~ 11 h 4.3 ~ 21.6 h [2] t 蚝虔 β t 蚝虔 β 7.5 d 17.8 ~ 19.8 d (2 ) mg L h 10% ~ [1] 60% 12 h - (CVVHD) 55% h 40% 3 1 g 3.1 < 60 min ph3 ~ 5 : 3.2 PK / PD (PAE) 3.3 MIC (T > MIC) 75% % ~ 95% [5] 1% ~ [1] 5% (15 ~ 20 mg kg -1 ) 4 g PAE 1 ~ 2 h [7] 4 ~ 5 MIC 3.4 PK / PD 3.5 PK / PD AUC 0-24 h / MIC AUC 0-24 h / 45% MIC MIC MRSA 70% AUC 0-24 h / MIC 400 [4] 20 60

(Chin J New Drugs Clin Rem)2011 8 30 563 ( < 10 mg L -1 ) (VISA) (hvisa) 10 mg L -1 ( ) ( IDSA MRSA ) [8] ( ) 15 ~ 20 mg L -1 3 1 g 12 h 4 h 1 MIC 10% ~ 60% ; 1 mg L -1 AUC 0-24 h / 12 h - MIC 400

3 (Chin J New Drugs Clin Rem) ( < 10 mg L -1 ) (VISA) (hvisa) 10 mg L -1 ( ) ( IDSA MRSA ) [8] ( ) 15 ~ 20 mg L g 12 h 4 h 1 MIC 10% ~ 60% ; 1 mg L -1 AUC 0-24 h / 12 h - MIC 400 (CVVHD) 55% 25 ~ 30 mg kg -1 ( ) 4 g d mg L -1 < 4 g d -1 1 g ( 1.5 (TDM) 2 g) 1.5 ~ 2 h [6] MIC 2 mg L -1 AUC 0-24 h / MIC [1] 400 TDM 15 ~ 20 mg kg -1 IDSA MRSA [8] 12 h 15 ~ 20 mg L -1 (30 ~ 65 mg L -1 ) 1% ~ 5% 1 Cockcroft- 14% ~ 35% TDM Gault (ml min -1 ) = (140- ) (kg) / ( K) 15 ~ 20 mg L -1 ; mmol L -1 K = 0.81; mg (2) dl -1 K = ; ; (3) 15 mg kg -1 1 TDM : (1) 2 2 IDSA MRSA [8] Matzke Moellering TDM

4 564 (Chin J New Drugs Clin Rem) ~ 4 CLSI VRSA 6 mm; Etest 30 min MIC 1 ~ 2 TDM ; 6 h ( ) [11] MRSA 9 (VRSA) MIC (CLSI) 2006 CLSI mg L -1 ; 8 ~ 16 mg L -1 ; 32 mg L L -1 β- ( ) 2 mg L -1 PK / PD D- -D- 20 ~ 40 mg L ~ 15 mg L -1 MIC 3 ~ 5 T > MIC T > 3MIC > 40% MIC 0.5 ~ 2 mg L -1 T > RNA MIC T > 3MIC 100% MRSA ( ) MRSA (MIC ) Etest MIC [12-14] STEINKRAUS MRSA MIC mg L mg L -1 [12] PK / PD [15] MIC MIC PK / PD AUC / MIC MIC CLSI 2 mg L -1 ; 4 ~ 8 mg L -1 ; 16 mg 80% MRSA CLSI MIC [16] Etest MIC

5 (Chin J New Drugs Clin Rem) MRSA 1.1% 4.1% 2010 MIC MIC 0.8% 3.8% [17] SENTRY MRSA 4 mg L -1 ) CLSI PRSP 10% 2010 [18] MIC MRSA MIC 1 MRSA MRSA 9 VRSA 2010 CHINET VRSA hvisa hvisa MIC (MIC 2 mg L -1 ) 4 mg L hvisa MRSA (CA-MRSA pneumonia) MIC (1 ~ 2 mg L -1 ) MRSA (HA-MRSA pneumonia) ( ventilator-associated pneumonia hvisa 9.5% [19] hvisa VISA VAP) ( healthcare asso- ciated pneumonia HCAP) CA-MRSA HA- MRSA MRSA [21] MIC MRSA HA- MRSA MIC MRSA MRSA ( community onset-mrsa CO- MRSA) MRSA (hospital onset-mrsa [22] ; HO-MRSA) MIC HCAP (hospital-acguired pneumonia HAP) VAP [20] 40% ( community-acquired pneumonia CAP) 25.5% (P < 0.001) HCAP MRSA IDSA MRSA [8] MRSA 3 (PRSP MIC 4 ( ) 1.1 MRSA MRSA CA-MRSA [23] 58.5% MRSA 1.2 (PNSP) PNSP (PISP) PRSP MIC CHINET 2009 PNSP 47.5% (PRSP 24.5% PISP 23%); 0.3% 3.5% 2009 PNSP (69.4%) (35.5%) [24] 2009

6 566 (Chin J New Drugs Clin Rem) [29] CHINET (29.0%) PRSP ( 710 ; ICU) CAP PRSP (PSSP) PISP PRSP ( 3 mo ) β- 95.0% 3.8% 1.3% 68.9% MIC 4 mg L % 13.7% 2.4 β- [25] CAP ( (MSSA) ) ) MRSA PRSP 3% ( MIC mg L -1 ) HAP 3 mo 13 3 [26] MRSA MIC < 2 mg L -1 1% 3.3 [27] 2 MRSA 2.1 CAP CAP ( ) CAP MRSA MRSA: (1) 1 ; (2) ; (3) ; (4) ; (5) 3 4 ( ) ( ); 2 (6) ; (7) 2.1 MRSA ( MIC > 1 mg L -1 ) [28] 2.2 HAP HAP ( VAP) 2.2 MSSA MRSA 20% ~ 30% MRSA : (1) ICU 90 d 2 ; MRSA (2) 65 ; (3) 5 d; HAP ( VAP) 15 ~ 20 mg L ~ 20 mg kg -1 q 8 ~ 12 h (600 mg qd 300 ~ 450 mg bid (4) 3 mo ; (5) ; (6) ; (7) CAP 2 MRSA

7 (Chin J New Drugs Clin Rem) mg kg ~ 60 mg kg -1 MRSA (VRE) 2 [8] / MRSA ; B β- B MRSA / 5% ~ 15% [3031] 62% ~ 75% MRSA 39% [32] (4% vs. 14% P = 0.03) [33] 1 h 3 MRSA 3.1 MRSA 1.0 g 2 wk 1 h 1.0 g ( ) ) 4 ~ 6 wk 1 MRSA MSSA [8] 2 2 / PRSP ( ) (1 ~ 4 wk) ICU ( 2 ~ 4 d

8 568 (Chin J New Drugs Clin Rem) (ANC) h ( ) 1.2 ANC ANC < L h ANC < L -1 2 ANC 2.1 ( > 7 d) 1.0 g q 12 h (ANC L -1 ) ( ) 6 mg kg -1 qd 2 bid 600 mg qd 600 mg bid 600 mg tid 2.2 ANC MRSA [34] : (1) 8 wk ( ; ) (2) / ; (3) MRSA PRSP ; (4) ; (5) X ; (6) (ESR) C [8] ( (CRP) ); (7) 1 [34] 3 ANC 3.1 ( ) MRSA 3.2 ANC 3 ~ 4 wk mo ANC ANC L -1 ( < 2 mo) 4.2 ( ) 2 d 80% 1 ~ 3 mo 3 wk 2 wk ( ) 3 ~ 6 mo

9 (Chin J New Drugs Clin Rem) > 3 wk (5%) (5%) ( < 30 d) + ± 1.4 A + ( > 30 d) + [ ( : + ) ] mg iv qd ( ) (1) (IE) IE IE G MIC 0.1 mg L -1 IE G+ G 2 g d -1 [810] TDM (2) IE ( 2 g d -1 TDM) ( ) (3) (30% ~ 40%) C (15% ~ 25%) (5% ~ 18%) ( ) (20% ~ 35%) [10] / G : : G : ( ) G / G MIC > 16 mg L -1 ( MRSA MSSA) + (2) G / 1.2 ( < + / + 2 mo) ( > 2 mo) (1) (40%) (40%) G MIC 0.1 ~ 0.5 mg L -1 G + G MIC 0.5 mg L (1) MSSA ( ) + (2) MRSA FDA

10 570 (Chin J New Drugs Clin Rem) % IDSA MRSA [8] MRSA 6 wk 24 ~ 48 h MRSA MRSA ( ) (1) MSSA ( ) wk; (2) MRSA g d -1 2 ~ 3 40 mg kg -1 d -1 3 ~ d; MSSA + + ; MRSA d IDSA MRSA [8] ; 300 mg q 8 h 6 wk; CDI CDI 1 mg kg -1 q 8 h 2 wk CDI ( ) (skin and soft-tissue infections SSTIs) CDI 500 mg tid 10 ~ SSTIs SSTIs 14 d CDI 125 mg qid 10 ~ 14 d CDI ( SSTIs: ) ; 500 mg qid po 500 mg ; 100 ml 0.9% 6 h 1 ; ; ; 500 mg q 8 h iv [35] ; CDI ( 1 2 ) 2 CDI MRSA ( ) 50% MRSA 7 ~ 14 d (CDI) 3 ( )

11 (Chin J New Drugs Clin Rem) MRSA MRSA (MRCNS) PRSP (MDRSP) MRSA 2 MRSA [36] MRSA CA-MRSA HA-MRSA 15 mg kg -1 AUC 0~24 h / MIC TDM 4 MRSA 15 ~ 20 mg L -1 AUC 0~24 h / MIC MRSA 400 mg h L MRSA : cssti 5 ~ 10 d; MRSA 2 ~ 6 wk; MRSA 3 ~ 4 wk 4 ~ 6 wk ; ( ) MRSA 2 wk 1.3 MRSA ( ) MRSA 3 15 mg kg [38] -1 ) q 6 h MRSA 2 wk; 4 ~ 6 wk ANC : ( transoesophageal echocardiography) MRSA ( ) ; 1.4 MRSA MRSA ; ; MRSA VRE PRSP ; MRSA SSTIs SSTIs CA-MRSA [37] (csstis) SSTIs 6 ~ 8 h [3] ( ) q 6 h 4 ~ 6 wk ; X ; 3.3 MIC MIC 1 mg L -1 ; MIC 1 ~ 2 mg L -1 ; MIC 2 mg L -1

12 572 (Chin J New Drugs Clin Rem) VA:Antimicrobial Therapy Inc 2011: [11] Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; 19th in- formational Supplement CLSI document M100-S19[S]. Wayne [1] PA USA: CLSI ( ) ( ): [ ] [1] RYBAK M LOMAESTRO B ROTSCHAFER JC et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists the Infectious Diseases Society of America and the Society of Infectious Diseases Pharmacists[J]. Am J Health Syst Pharm (1): [2] KRIVOY N PELEG S POSTOVSKY S et al. Pharmacokinetic analysis of vancomycin in steady state in pediatric cancer patients[j]. Pediatr Hematol Oncol (4): [3] ARROYO JC QUINDLEN EA. Accumulation of vancomycin after intraventricular infusions[j]. South Med J (12): [4] BAILIE GR NEAL D. Vancomycin ototoxicity and nephrotoxicity. A review[j]. Med Toxicol Adverse Drug Exp (5): [5] MOHAMMEDI I DESCLOUX E ARGAUD L et al. Loading dose of vancomycin in critically ill patients: 15 mg / kg is a better choice than 500 mg[j]. Int J Antimicrob Agents (3): [6] LODISE TP LOMAESTRO B GRAVES J et al. Larger vancomycin doses (at least four grams per day) are associated with an incresed incidence of nephrotoxicity[j]. Antimicrob Agents Chemother (4): [7]. [M]. : : [8] LIU C BAYER A COSGROVE SE et al. Clinical practice [20] HOWDEN BP DAVIES JK JOHNSON PD et al. Reduced vancomycin susceptibility in Staphylococcus aureus including guidelines by the infectious diseases society of america for the vancomycin-intermediate and heterogeneous vancomycin-intermediate treatment of methicillin-resistant Staphylococcus aureus infections in adults and children[j]. Clin Infect Dis (3): strains: resistance mechanisms laboratory detection and clinical implications[j]. Clin Microbiol Rev (1): e [9] National Health Service. Prescribing guidelines for intravenous vancomycin in adults [EB / OL]. ( ) [ ]. http: / / / pdf_doc_files_etc / MMC041_Vancomycin_Guidelines. pdf. [10] GILBERT DN MOELLERING RC ELIOPOULOS MG. The Sanford guide to antimicrobial therapy [M]. 41ed. Sperryville [12] STEINKRAUS G WHITE R FRIEDRICH L. Vancomycin MIC creep in non-vancomycin-intermediate Staphylococcus aureus (VISA) vancomycin-susceptible clinical methicillin-resistant S. aureus (MRSA) blood isolates from [J]. J Antimicrob Chemother (4): [13] RYBAK MJ LEONARD SN ROSSI KL et al. Characterization of vancomycin-heteroresistant Staphylococcus aureus from the metropolitan area of Detroit Michigan over a 22-year period (1986 to 2007)[J]. J Clin Microbiol (9): [14] WANG G HINDLER JF WARD KW et al. Increased vancomycin MICs for Staphylococcus aureus clinical isolates from a university hospital during a 5-year period [J]. J Clin Microbiol (11): [15] HOLMES RL JORGENSEN JH. Inhibitory activities of 11 antimicrobial agents and bactericidal activities of vancomycin and daptomycin against invasive methicillin-resistant Staphylococcus aureus isolates obtained from 1999 through 2006[J]. Antimicrob Agents Chemother (2): [16] ALOS JI GARCIA-CANAS A GARCIA-HIERRO P et al. Vancomycin MICs did not creep in Staphylococcus aureus isolates from 2002 to 2006 in a setting with low vancomycin usage[j]. J Antimicrob Chemother (4): [17] REYNOLDS R HOPE RWAMER M et al. The illusion of MIC creep in MRSA[EB / OL]. ( )[ ]. http: / / org / publications. jsp? id=&action =next&- page=2009. [18] JONES RN. Microbiological features of vancomycin in the 21st century: minimum inhibitory concentration creep bactericidal / static activity and applied breakpoints to predict clinical outcomes or detect resistant strains[j]. Clin Infect Dis Suppl 1: S [19] [J] (11): [21] MAREE CL DAUM RS BOYLE-VAUYA S et al. Communityassociated methicillin-resistant Staphylococous aureus isolates causing healthcare-associated infections[j]. Emerg Infect Dis (2): [22] KLEVENS RM MORRISON MA NADLE J et al. Invasive methicillin-resistant Staphylococcus aureus infections in the

13 (Chin J New Drugs Clin Rem) United States[J]. JAMA (15): [23] KOLLEF MH SHORRE A TABDK YB et al. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia[j]. Chest (6): [24] (7): [J]. [33] TANCCONELLI E CATALDO MA ALBANESE A et al. Vancomycin versus cefazolin prophylaxis for cerebrospinal (11): shunt [25] CHINET [J] (5): [26]. [J] (2): [34] FREIFELD AG BOW EJ SEPKOWITZ KA et al. Clinical [27] BIOTEN MSM GAILLARD CA van TIEL FH et al. Colonization practice guideline for the use of antimicrobial agents in and infection with Enterococcus faecalis in intensive care units: the role of antimicrobial agents[j]. Animicrob Agents Che-mother (12): neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America[J]. Clin Infect Dis (4): [28] GRAFFUNDER EM VENEZIA RA. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials[j]. J Antimicrob Chemother (6): [29] PEA F VIALE P. The antimicrobial therapy puzzle: could pharmacokinetic-pharmacodynamic relationships be helpful in addressing the issue of appropriate pneumonia treatment in critically ill patients?[j]. Clin Infect Dis (12): [30] DRAKE JM KESTLE JR MILNER Ret al. Randomized trial of cerebrospinal fluid shunt value design in pediatric hydrocephalus[j]. Neurosurgery (2): [31] WHITEHEAD WE KESTLE JR. The treatment of cerebrospinal fluid shunt infections. Results from a practice survey of the American Society of Pediatric Neurosurgeons[J]. Pediatr Neurosurg (4): [32] FEDERICO G TUMBARELLO M SPANU T et al. Risk factors and prognostic indicators of bacterial meningitis in a cohort of 3580 postneurosurgical patients[j]. Scand J Infect Dis placement in a hospital with a high prevalence of methicillinresistant Staphylococcus aureus[j]. J Hosp Infect (4): [35] STEVENS DL BISNO AL CHAMBERS HF et al. Practice guidelines for the diagnosis and management of skin and softtissue infections[j]. Clin Infect Dis (10): [36]. [J] (1): [37] Center for Disease Control and Prevention. Four pediatric deaths from community-acquired methicillin-resistant staphylococcus aureus Minnesota and North Dakota [J]. MMWR Morb Mortal Wkly Rep (32): [38]. [EB / OL]. ( )[ ]. CL0056 / html. http: / / / WS01 / 3 9

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ºî½×2-p174-184 174 美國感染症醫學會 Methicillin 抗藥性金黃色葡萄球菌治療指引李倩瑜 1 鄭舒倖 2 行政院衛生署桃園醫院 1 小兒科 2 感染科 (IDSA) 2011 methicillin (methicillin-resistant Staphylococcus aureus; MRSA) (practice guidelines)[1]