Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No CA-MRSA HA-MRSA 1 1 CA-MRSA HA-MRSA HA-MRSA CA-MRSA 1 MRSA MRSA M

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1 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No Methicillin-resistant staphylococcus aureus MRSA 1961 MRSA 1 MRSA 2 community-acquired MRSA CA-MRSA 3 4 MRSA 2010 MRSA MRSA 1. meca MIC 2 μg / ml MRSA MRSA β MRSA healthcare-associated MRSA HA-MRSA MRSA HA-MRSA community-onset 1 2 MRSA 3 1 hospital-onset 48 MRSA 2 MRSA community-associated MRSA CA-MRSA 48 MRSA MRSA 1 DOI /cma. j. issn

2010 MRSA MRSA 1. meca MIC 2 μg / ml MRSA MRSA β- 2.

2 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No CA-MRSA HA-MRSA 1 1 CA-MRSA HA-MRSA HA-MRSA CA-MRSA 1 MRSA MRSA MRSA PVL β- PVL 3. The Clinical and Laboratory Standards Institute CLSI 2006 MIC < 4 mg /L VSSA MIC 8 ~ 16 mg /L Vancomycin-intermediate Staphylococcus aureus VISA MIC > 32 mg /L Vancomycin-resistant Staphylococcus aureus VRSA MRSA AIDS 5 MRSA MRSA 2008 Mohnarin 6-7 MRSA 67. 6% ICU 84. 8% 7 MRSA 26. 3% 9% MRSA 66. 2% MRSA 80% 50% 8 MRSA SCCmecⅢ CA-MRSA CA- MRSA MRSA 75% 9-10 CA-MRSA TSS CA-MRSA HA-MRSA β CA-MRSA SCCmecⅣa 11 MRSA MRSA

The Clinical and Laboratory Standards Institute CLSI 2006 MIC < 4 mg /L VSSA MIC 8 ~ 16 mg /L Vancomycin-intermediate Staphylococcus aureus VISA

3 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No. 3 1 β MRSA meca MRSA 2a Penicillin-binding protein 2a PBP2a β PB- Ps PBPs β MRSA β β MRSA β 2 vana PBP2 PBP4 3 Staphylococcall cassette chromosome mec SCCmec meca meca MRSA MRSA CLSI 33 ~ μg 30μg meca MRSA meca MIC MIC 4μg /ml meca PBP2a 2. 6μg /ml 4% W /V MRSA 3. MRSA meca PCR 2 ~ 4 MRSA meca 1 MRSA PBP2a 6μg /ml MRSA 1. Vancomycin MRSA C MSSA β MSSA β 14

Staphylococcall cassette chromosome mec SCCmec meca meca MRSA MRSA CLSI 33 ~ 35 24 1 12-13 1.

4 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No VRSA MIC AUC /MIC AUC /MIC 400 MIC 1 μg /ml 15 ~ 20 μg /ml MIC 0. 5 μg /ml MIC 2 μg /ml 15 ~ 20 μg /ml 15 ~ 20 mg /kg / 8 ~ g MRSA 25 ~ 30 mg /kg 2 4 ~ 5 MIC 2μg /ml MIC > 2μg /ml VISA VRSA 2. MRSA ~ 1. 6 g2 ~ 4 16 ~ 32 mg /kg2 AUC /MIC 1000 mg / 2 > 60 kg 1200 mg / mg / 1 ~ mg / 1 ~ mg / 6 ~ Teicoplanin % 90% ~ 95% mg /kg mg /L 4 MRSA 2

5 μg /ml MIC 2 μg /ml 15 ~ 20 μg /ml 15 ~ 20 mg /kg / 8 ~ 12 1 2 g MRSA 25 ~ 30 mg /kg 2 4 ~ 5 MIC 2μg /ml MIC > 2μg /ml VISA VRSA

5 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No MRSA VISA VRSA FDA C 2 5. SMZ-TMP 95% ~ 100% CA-MR- SA SSTI SMZ-TMP MSSA 2-6. CA-MRSA CA-MR- SA HA-MRSA 20% B 7. Daptomycin μg /ml 90% ~ 95% 7 ~ % MRSA mg /kg 1 6 mg /kg 1 30 B Linezolid 50 S 23S % 31% 65% 5 MRSA

6 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No VISA VRSA MRSA 23S RNA cfr 2503 C 9. / quinupristin dalfopristin 70S 50S 1 ~ 3 16 MRSA 7. 5 mg /kg5% 60 B 10. MRSA 600 mg / 900 mg / 2 ~ Tigecycline FDA 1 μg /ml Ⅲ /Ⅳ FDA 8 D 12. Fusidic acid MRSA MRSA MRSA 2 ~ 4 MRSA MRSA ICU

/ quinupristin dalfopristin 70S 50S 1 ~ 3 16 MRSA 7. 5 mg /kg5% 60 B 10.

7 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No. 3 MRSA MSSA MRSA MRSA 2 MRSA MRSA MRSA MRSA 2 2 MRSA - 5% ~ 10% MRSA GISA GRSA 28 / GISA GRSA P450 3 UTIs UTIs MRSA

8 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No CA-MRSA 62. 6% SMZ-TMP 33 3 MRSA MRSA 4 5 SMZ-TMP 1 2 CA-MRSA 5 ~ 10 6 CA-MRSA TMP-SMX 7 MRSA MRSA β 7 ~ 14 Mohnarin MRSA 36. 4% MRSA 90% 43. 8% 12. 9% MRSA / 8

9 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No MRSA MRSA 2 MRSA % MRSA 2 4 ~ ~ 10 mg /kg mg mg /kg / TEE TTE 2 ~ 4 13 > 10 mm 2 1 MRSA 40% 15 ~ 20 μg /ml 44

3 4 36-37 38 9 MRSA MRSA 2 MRSA 23 39-40 5% 41-43 10 MRSA 2 4 ~

10 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No / MRSA MRSA MRSA MRSA MRSA MRSA MRSA 14 ICU MRSA MRSA MRSA 15 MR- SA > 7 ICU 3 MRSA 16 MRSA 48 7 ~ 21 1% 5% 66% TMP-SMX TMP 13% ~ 53% SMX 17% ~ 63% CSF 22% MRSA 17 MRSA MRSA 19 1 MRSA MRSA MRSA 2 MRSA MRSA MRSA MRSA

MR- SA > 7 ICU 3 MRSA 16 MRSA 48 7 ~ 21 1% 5% 66% TMP-SMX TMP 13% ~ 53% SMX 17%

11 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No. 3 ICU MRSA 80% MRSA 92% MRSA 1. ICU MRSA 2. MRSA MRSA MRSA MRSA 3. MRSA MRSA 4. MRSA MRSA 5. MRSA 1 Matouskova I Janout V. Current knowledge of methicillin-resistant Staphylococcus aureus and community-associated methicillinresistant Staphylococcus aureus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub Liu C Bayer A Cosgrove SE et al. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children. Clinical Infectious Diseases e18- e MRSA Mera RM Suaya JA Amrine-Madsen H et al. Increasing Role of Staphylococcus aureus and Community-Acquired Methicillin- Resistant Staphylococcus aureus Infections in the United States A 10-Year Trend of Replacement and Expansion. Microb Drug Resist Boucher HW Corey GR. Epidemiology of methicillin-resistant Staphylococcus aureus. Clin Infect Dis Suppl 5 S344- S Mohnarin Mohnarin Mohnarin Nathwani D Morgan M Masterton RG et al. Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus MRSA infections presenting in the community. J Antimicrob Chemother Farley JE. Epidemiology clinical manifestations and treatment options for skin and soft tissue infection caused by community-acquired methicillin-resistant Staphylococcus aureus. J Am Acad Nurse Pract

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008 152 2 191-202. 2 Liu C Bayer A Cosgrove SE et al.

12 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No Sturenburg E. Rapid detection of methicillin-resistant Staphylococcus aureus directly from clinical samples methods effectiveness and cost considerations. Ger Med Sci Doc Rybak MJ Lomaestro BM Rotschafer JC et al. Vancomycin Therapeutic Guidelines A Summary of Consensus Recommendations from the Infectious Diseases Society of America the American Society of Health-System Pharmacists and the Society of Infectious Diseases Pharmacists. Clin Infect Dis Kullar R Davis SL Levine DP et al. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia support for consensus guidelines suggested targets. Clin Infect Dis Svetitsky S Leibovici L Paul M. Comparative efficacy and safety of vancomycin versus teicoplanin systematic review and metaanalysis. Antimicrob Agents Chemother Cavalcanti AB Goncalves AR Almeida CS et al. Teicoplanin versus vancomycin for proven or suspected infection. Cochrane Database Syst Rev CD Rose WE Kaatz GW Sakoulas G et al. Teicoplanin pharmacodynamics in reference to the accessory gene regulator agr in Staphylococcus aureus using an in vitro pharmacodynamic model. J Antimicrob Chemother Carpenter CF Chambers HF. Daptomycin another novel agent for treating infections due to drug-resistant gram-positive pathogens. Clin Infect Dis Tally FP DeBruin MF. Development of daptomycin for gram-positive infections. J Antimicrob Chemother Vilay AM Grio M Depestel DD et al. Daptomycin pharmacokinetics in critically ill patients receiving continuous venovenous hemodialysis. Crit Care Med Rybak MJ Bailey EM Lamp KC et al. Pharmacokinetics and bactericidal rates of daptomycin and vancomycin in intravenous drug abusers being treated for gram-positive endocarditis and bacteremia. Antimicrob Agents Chemother FDA Cubicin Arnold SR ED Buckingham SC et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop CHINET Mohnarin Mohnarin Mohnarin S1-S5. 36 Swoboda S Helbig L Kommerell M et al. Bone tissue and plasma concentrations of linezolid and vancomycin in rabbits with prosthesis-related infection due to MRSA. Pharmazie Nam JR Kim MS Lee CH et al. Linezolid Treatment for Osteomyelitis due to Staphylococcus Epidermidis with Reduced Vancomycin Susceptibility. J Korean Neurosurg Soc Picazo JJ Betriu C Culebras E et al. Methicillin-resistant Staphylococcus aureus changes in the susceptibility pattern to daptomycin during a 10-year period Rev Esp Quimioter Sacar M Sacar S Cevahir N et al. Comparison of antimicrobial agents as therapy for experimental endocarditis caused by methicillin-resistant Staphylococcus aureus. Tex Heart Inst J Guskey MT Tsuji BT. A comparative review of the lipoglycopeptides oritavancin dalbavancin and telavancin. Pharmacothera-

14 Rybak MJ Lomaestro BM Rotschafer JC et al.

13 Chin J Exp Clin Infect Dis Electronic Edition August 2011 Vol 5 No. 3 py Chen LY Huang CH Kuo SC et al. High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus Case report. BMC Infect Dis Vilay AM Depestel DD Mueller BA. Daptomycin pharmacokinetics in critically ill patients undergoing continuous renal replacement therapy. Crit Care Med Wu G Abraham T Rapp J et al. Daptomycin evaluation of a high-dose treatment strategy. Int J Antimicrob Agents Haque NZ Zuniga LC Peyrani P et al. Relationship of vancomycin minimum inhibitory concentration to mortality in patients with methicillin-resistant Staphylococcus aureus hospital-acquired ventilator-associated or health-care-associated pneumonia. Chest Walkey AJ O Donnell MR Wiener RS. Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia a meta-analysis of randomized controlled trials. Chest Wunderink RG Rello J Cammarata SK et al. Linezolid vs vancomycin analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest Mohnarin J /CD

42 Vilay AM Depestel DD Mueller BA. Daptomycin pharmacokinetics in critically ill patients undergoing continuous renal replacement therapy. Crit Care Med 2011 39 5 1243-1245.

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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]