據(jù)JAMA最新研究披露,，在西班牙的12個(gè)加護(hù)病房（ICU）中的對(duì)利奈唑胺和甲氧苯青霉素耐藥的金黃色葡萄球菌（LRSA）的感染爆發(fā)與醫(yī)院內(nèi)的細(xì)菌傳播和廣泛使用抗菌藥物利奈唑胺有關(guān)。利奈唑胺常常用于治療嚴(yán)重的感染；而減少利奈唑胺的使用及感染控制的舉措則與該感染爆發(fā)的消退有關(guān),。
對(duì)甲氧苯青霉素耐藥的金黃色葡萄球菌（MRSA）是與治療有關(guān)的感染的一個(gè)重大原因,。對(duì)嚴(yán)重MRSA感染的治療選項(xiàng)有限（例如，對(duì)與呼吸機(jī)使用有關(guān)的MRSA肺炎僅推薦使用利奈唑胺和糖肽[肽的一類(lèi)]）,。據(jù)文章的背景資料,，利奈唑胺因?yàn)槠淇咕V,、良好的安全特性、藥代動(dòng)力學(xué)/藥效動(dòng)力學(xué)及其有效性而被廣泛用于重癥患者的治療,。對(duì)利奈唑胺耐藥的金黃色葡萄球菌極為罕見(jiàn)。
Hospital Clinico San Carlos 及 Universidad Complutense, Madrid, Spain的Miguel Sanchez Garcia, M.D., Ph.D. 及其同僚對(duì)一次LRSA的爆發(fā)及其所應(yīng)用的感染控制舉措進(jìn)行了檢查。該項(xiàng)研究包括了在西班牙馬德里的一家有1000個(gè)床位的三級(jí)大學(xué)教學(xué)醫(yī)院的重癥加護(hù)部門(mén)的身上存在或感染了LRSA的重癥病人,。
在2008年4月13日至6月26日期間發(fā)現(xiàn)了12名LRSA患者,。有6位病人的LRSA引起了與呼吸機(jī)有關(guān)的肺炎，有3位病人則引起了LRSA的菌血癥,。在所有的分離菌株中的利奈唑胺的耐藥性都證明與cfr基因相關(guān),。文章的作者寫(xiě)道：“除了一例之外,，其它的可能的醫(yī)院人員耐藥菌攜帶者和環(huán)境樣本皆呈陰性,。有6名病人死亡,，其中5名是ICU患者,，其中一人的死亡被歸因于LRSA感染,。利奈唑胺從2008年4月的每日202次規(guī)定劑量的使用降低至2008年7月的25次規(guī)定劑量的使用,。在2008年7月至2010年4月期間，在每周的監(jiān)控培養(yǎng)或診斷性樣本中沒(méi)有發(fā)現(xiàn)新發(fā)的耐藥病例。”
文章的作者寫(xiě)道：“在ICU中發(fā)生12名患者的LRSA感染爆發(fā)的報(bào)告據(jù)我們所知還是第一次，而且它也是與cfr基因介導(dǎo)的利奈唑胺抗藥性的第一次報(bào)道。表觀(guān)風(fēng)險(xiǎn)因子是以往對(duì)利奈唑胺的使用。”
“鑒于目前社區(qū)獲得性MRSA感染的增加,，我們的數(shù)據(jù)對(duì)住院病人和門(mén)診病人都具有重要的意義,?？咕幬锢Ｆ胶退箧滄咚岬慕M合療法仍然需要在臨床的環(huán)境中進(jìn)行評(píng)估,。”（生物谷Bioon.com）
生物谷推薦原文出處：
JAMA. 2010;303[22]:2260-2264
Clinical Outbreak of Linezolid-Resistant Staphylococcus aureus in an Intensive Care Unit
Miguel Sánchez García, MD, PhD; María ángeles De la Torre, MD; Gracia Morales, PhD; Beatriz Peláez, PhD; María José Tolón, MD; Sara Domingo, MD; Francisco Javier Candel, MD, PhD; Raquel Andrade, PhD; Ana Arribi, MD, PhD; Nicolás García, MD; Fernando Martínez Sagasti, MD, PhD; José Fereres, MD, PhD; Juan Picazo, MD, PhD
Context Linezolid resistance is extremely uncommon in Staphylococcus aureus.
Objective To report an outbreak with linezolid and methicillin-resistant S aureus (LRSA) in an intensive care department and the effective control measures taken.
Design, Setting, and Patients Outbreak study of consecutive critically ill patients colonized and/or infected with LRSA at an intensive care department of a 1000-bed tertiary care university teaching hospital in Madrid, Spain. Patients were placed under strict contact isolation. Daily updates of outbreak data and recommendations for the use of linezolid were issued. Extensive environmental sampling and screening of the hands of health care workers were performed.
Main Outcome Measures Linezolid use and clinical and epidemiological characteristics and outcomes using minimal inhibitory concentrations, pulsed-field gel electrophoresis, and polymerase chain reaction of LRSA isolates.
Results Between April 13 and June 26, 2008, 12 patients with LRSA were identified. In 6 patients, LRSA caused ventilator-associated pneumonia and in 3 patients it caused bacteremia. Isolates were susceptible to trimethoprim-sulfamethoxazole, glycopeptides, tigecycline, and daptomycin. Genotyping identified 1 predominant clone and 3 other types. Cfr-mediated linezolid resistance was demonstrated in all isolates. Potential hospital staff carriers and environmental samples were negative except for one. Six patients died, 5 of them in the intensive care unit, with 1 death attributed to LRSA infection. Linezolid use decreased from 202 defined daily doses in April 2008 to 25 defined daily doses in July 2008. Between July 2008 and April 2010, no new cases have been identified in the weekly surveillance cultures or diagnostic samples.
Conclusions The first clinical outbreak, to our knowledge, with LRSA mediated by the cfr gene developed at our center, was associated with nosocomial transmission and extensive usage of linezolid. Reduction of linezolid use and infection-control measures were associated with the termination of the outbreak.
