(Methicillin2resistant staphylococcus aureus, MR2, MRSA, MRSA. ( community2acquired MRSA, CA2MRSA ), , (MRSA ) MR2. MRSA, MRSA ( hosp ital2acquired

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() 20105 4 2Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No.

1 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No (Methicillin2resistant staphylococcus aureus, MR2 SA ), 1961 MRSA [ 1 ],MRSA,,, MRSA, ( community2acquired MRSA, CA2MRSA ), MRSA,,,(), ( 1) [ 2 ], MRSA,,, MRSA,, 1 A B C 1. :, (MRSA ) MR2 SA 2. : MRSA, MRSA ( hosp ital2acquired DO I: /cma. j. issn

2 216 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No. 2 MRSA, HA2MRSA ) MRSA ( healthcare2associated MRSA, HA2 MRSA ) HA2MRSA( ) ( ) ( community2onset) : : (1) ; ( 2)MRSA ; ( 3) 12, ( hosp ital2onset) :48 h 3. : MRSA,MRSA, MRSAMRSA ( community2associated MRSA, CA2MRSA ) ( community2acquired MRSA, CA2MRSA ) CA2 MRSA, CA2MRSA,, Panton2Valentine ( Panton2Valentine leukoci2 din, PVL),, CA2MRSA: ( 1) MRSA 48 h ; ( 2) 1,; (3) ; (4)MRSA, CA2MRSA,MRSA MRSA, MRSA( 2) [ 2 ] 2MRSA MRSA HA2MRSA CA2MRSA,,,,, PVL, SCCmec PVL, SCCmec MRSA MRSA,,, () 1. meca: meca R, 78 kd 2a ( penicillin2binding p rotein 2a,

3 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No PBP2a), MRSA PBP2a,MRSA, meca mec( staphylococcal cassette chromosome mec, SCCmec), SCCmec,, MRSA SCCmecMRSA 2. VanA: VanA, D22D2, D2 D2,, 3. rrna :, / () MRSA, MSL, () MRSA,, () MRSA,,,, MRSA , MRSA,MRSA [ 3 ] : MRSA 37. 4%,MRSA 80%, 60%,30%, MRSA Mohnarin [ 4 ] : MRSA 61. 6%,MRSA 80%, 50%,, MRSA SCCmec CA2MRSA,, CA2 MRSAMRSA75%CA2MRSA

4 218 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No. 2,( TSS) CA2MRSA HA2MRSA,, CA2MRSA, CA2MRSA MRSA1. 1% [ 5 ], SCCmec PVL MRSA ( The Clinical and Laboratory Standards Institu2 te, CLSI) [ 6 ], 6 g/m l PBP2aMRSA, meca 1. : ( 1 ) : ( 30g/m l) (4g/m l) MRSA,mecA ( 2) :4% NaCl MHA,6g/m l meca MRSA( 3):MRSA, 24 hmrsa (4):,,, MRSA,34 h, MRSA 2. :PBP2aMRSA,,, MRSA 3. :nucmeca,, meca MRSA PCR24 h MRSA,MRSA MRSA MRSA,,ICU MRSA, (MSSA ) [ 7 ] 1:MRSA,MRSA, MRSA,[ ] MRSA,, ( 2), () 1. :, MRSA, 90%,MRSA [ 5 ],

5 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No , 5 cm [ 8, 9 ] 2:MRSA, [ B] [ ] 2. 3: MRSA,, MRSA,MRSA [ ] 3. / : MRSA [ 10 ] MRSA, [ 11 ] [ 12 ], PVL MRSA, D, 4: (1)[ B ],, [ ] (2), [ B ]( ),MRSA, [ B] (3),,,[ ] 4. 5:,, [ B] () Mohnarin [ 13 ], 7%, MRSA36. 4%, MRSA 90%,43. 8%,12. 9%,,, 2 /3,80%,,83%, 93% [ 14 ] 2, [ 15 ] 6:,

6 220 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No. 2 [ ], [ ] (),,, 4, [ 16 ],, ( ) [ 17 ] [ 18 ] 7:MRSA MRSA, ( 2 d), [ ] () Mohnarin [ 19 ], 6. 8%, MRSA 51. 2%, MRSA,5%, 8: MRSA, 14 d 6 4, [ ] () MRSA, 40%,, ( 1520) mg/l,/ MRSA,MRSA MRSA,,,MRSA COPD,,,

7 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No MRSA,, MRSA,MRSA 9: ( 1) MRSA [ ](2),MRSA ( ) ;, [ ] () MRSA,,, 10: (1)MRSA,, ( ) (2) MRSA, ( ) (3) ( ) () 11: (1) MRSA, MRSA, MRSA MRSA,( ) (2) MRSA,( ) MRSA MRSA ICU,MRSA 80%MRSA, 92% MRSA,,MRSA 1. ICU, MRSA( ) 2. MRSA MRSA, MRSA ( ) MRSA, MRSA( ) 3. :MRSA, MRSA, () MRSA, ( )

8 222 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No. 2 3MRSA, ;, ;, ;, ;,, ; ;,, ;;; GISA; GRSA 5% 10% ; MRSA ; ; ; 28 d; ; ( ; ) ; GISA; GRSA ; P450 / ; ;;, ;( ) ; ;( ) ; ;, ; UTIs; UTIs; ;;, ; ;, 4. :MRSA, MRSA, ( ) 5. :MRSA,,,( )

9 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No () : : 1Gould FK, B rindle R, Chadwick PR, et al. Guidelines (2008) for the p rophylaxis and treatment of methicillin2resistant Staphylo2 coccus aureus (MRSA) infections in the United Kingdom. J Antim icrob Chemother, 2009, 63: Matouskova I, Janout V. Current knowledge of methicillin2resistant Staphylococcus aureus and community2associated methicillin2 resistant Staphylococcus aureus. B iomed Pap Med Fac Univ Palacky O lomouc Czech Repub, 2008, 152: , W einstein AJ,.., 2001, 81: ,. Mohnarin :., 2008, 33: L iu Y, Kong F, Zhang X, et al. Antim icrobial suscep tibility of Staphylococcus aureus isolated from children with impetigo in Chi2 na from 2003 to 2007 shows community2associated methicillin2resistant Staphylococcus aureus to be uncommon and heterogeneous. B r J Dermatol, 2009, 161: CDC DoHaHS. Laboratory Detection of: Oxacillin /Methicillin2resistant Staphylococcus aureus Available from: http: / / www. cdc. gov/ncidod /hip /Lab /FactSheet/m rsa. htm. 7Nathwani D, Morgan M, Masterton RG, et al. Guidelines for UK p ractice for the diagnosis and management of methicillin2resist2 ant Staphylococcus aureus (MRSA) infections p resenting in the community. J Antim icrob Chemother, 2008, 61: ,,.., 2008, 41: Hammond SP, Baden LR. Clinical decisions. Management of skin and soft2tissue infection2polling results. N Engl J Med, 2008, 359: CenizalMJ, SkiestD, Luber S, et al. Prospective random ized trial of emp iric therapy with trimethop rim2sulfamethoxazole or doxy2 cycline for outpatient skin and soft tissue infections in an area of high p revalence of methicillin2resistant Staphylococcus aureus. Antim icrob Agents Chemother, 2007, 51: W eigelt J, Itani K, Stevens D, et al. L inezolid versus vancomycin in treatment of comp licated skin and soft tissue infections. An2 tim icrob Agents Chemother, 2005, 49: A rbeit RD, Maki D, Tally FP, et al. The safety and efficacy of dap tomycin for the treatment of comp licated skin and skin2struc2 ture infections. Clin Infect D is, 2004, 38: ,. Mohnarin : , 33: , W agenlehner FM, Lehn N, W itte W, et al. In vitro activity of dap tomycin versus linezolid and vancomycin against gram2positive uropathogens and amp icillin against enterococci, causing comp licated urinary tract infections. Chemotherapy, 2005, 51: Stein GE, Craig WA. Tigecycline: a critical analysis. Clin Infect D is, 2006, 43: Rao N, Ham ilton CW. Efficacy and safety of linezolid for Gram2positive orthopedic infections: a p rospective case series. D iagn M icrobiol Infect D is, 2007, 59: B liziotis IA, Plessa E, Peppas G, et al. Dap tomycin versus other antim icrobial agents for the treatment of skin and soft tissue in2 fections: a meta2analysis. Ann Pharmacother, 2010, 44: Kandem ir O, Oztuna V, Colak M, et al. Comparison of the efficacy of tigecycline and teicop lanin in an experimental methicillin2 resistant Staphylococcus aureus osteomyelitis model. J Chemother, 2008, 20: , Mohnarin., 2008, 18: ( : ) ( :). [ J /CD ]. :, 2010, 4 (2) :

Community2acquired methicill in2resistant St a p hyl ococcus a ureus

376 : ; ; ; :R978. 11 :A :100927708 (2005) 0620376205 Community2acquired methicill in2resistant St a p hyl ococcus a ureus W A N G Fu. ( I nstit ute of A ntibiotics, H uashan Hos pit al, S hang hai 200040,