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临床用药|血培养 MSSA，选择万古、利奈还是头孢唑啉？( 二 )

  • MSSA 菌血症首选耐酶青霉素与一代头孢类 ， 万古霉素、利奈唑胺不作为首选；
  • 金葡菌血症非常复杂 ， 复发率死亡率较高 ， 需要多学科协作 ， 感染灶控制与引流非常重要；
  • 抗菌疗程：无并发症的血培养转阴后 14 天 ， 有并发症的疗程至少 4-6 周 。
投稿 | drugs@dxy.cn 题图 | 站酷海洛参考文献
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2. Fernandez Guerrero ML, de Gorgolas M. Comparative activity of cloxacillin andvancomycin against methicillin-susceptible Staphylococcus aureus experimen-tal endocarditis. J Antimicrob Chemother. 2006;58:1066–9.
3. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF; Infectious Diseases Society of America. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55.
4. LaPlante KL, Rybak MJ. Impact of high-inoculum Staphylococcus aureus on the activities of nafcillin, vancomycin, linezolid, and daptomycin, alone and in combination with gentamicin, in an in vitro pharmacodynamic model. Antimicrob Agents Chemother 2004; 48:4665–72.
5. Gudiol F, Aguado JM, Almirante B, et al. Diagnosis and treatment of bacteremia and endocarditis due to Staphylococcus aureus. A clinical guideline from the Spanish Society of Clinical Microbiology andInfectious Diseases (SEIMC). Enfermedades Infecc Y Microbiol Clínica. 2015;33:625, e1–625.e23
6. John E. Bennett, Raphael Dolin, Martin J. Blaser. Mandell Douglas and Bennett's Principles and Practice of Infectious Diseases, 9th Edition. 2019.
7. Naber C, Baddour L, Giamarellos-Bourboulis E, et al. Clinical consensus conference: survey on gram-positive bloodstream infections with a focus on Staphylococcus aureus. Clin Infect Dis. 2009;48: S260–S70.
8. Small PM, Chambers HF. Vancomycin for Staphylococcus aureus endocarditis in intravenous drug users. Antimicrob Agents Chemother 1990; 34:122731.
9. Stryjewski ME, Szczech LA, Benjamin DK Jr., et al Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis dependent patients with methicillin-susceptible Staphylococcus aureusbacteremia. Clin Infect Dis 2007; 44:1906.
10. Chang FY, Peacock JE Jr., Musher DM, et al Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospectivemulticenter study. Medicine(Baltimore)2003;82:3339.
11. Kim SH, Kim KH, Kim HB, et al Outcome of vancomycin treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia.Antimicrob Agents Chemother 2008; 52:1927.
12. Lodise TP Jr., McKinnon PS, Levine DP, et al Impact of empirical therapy selection on outcomes of intravenous drug users with in fective endocarditis caused by methicillin-susceptible Staphylococcusaureus. Antimicrob Agents Chemother 2007; 51:37313.


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