對萬古黴素感受性下降之金黃色葡萄球菌

Staphylococcus aureus with Reduced Susceptibility to Glycopeptides

金黃色葡萄球菌（Staphylococcus aureus）在臨床上除了可以造成各式各樣的感染症，一直以來它也是各種醫療照護感染最重要的致病菌之一。就抗生素的發展歷史來看，雖然一直不乏可以治療金黃色葡萄球菌的藥物，就青黴素（penicillin）到甲氧苯青黴素（methicilline）再到萬古黴素（vancomycin），但隨著抗藥菌株的散布，臨床上可以使用的有效抗生素越來越少，這也增加了選擇經驗性抗生素治療的難度。近年來金黃色葡萄球菌對萬古黴素的感受性逐漸降低，特別是異質性萬古黴素抗藥性金黃色葡萄球菌（heterogeneous vancomycin- intermediate S. aureus, hVISA）和萬古黴素抗藥性金黃色葡萄球菌（包括vancomycin intermediate S. aureus, VISA和vancomycin-resistant S. aureus, VRSA）的出現，在臨床上造成很大的衝擊，因為向來被認為治療抗甲氧苯青黴素金黃色葡萄球菌（methicillin-resistant S. aureus, MRSA）的首選藥物萬古黴素，目前也變得不可靠了。這些對萬古黴素感受性下降的金黃色葡萄球菌除了在臨床上造成治療的困難之外，對於臨床的微生物室而言，偵測這些相對抗藥性的菌株（hVISA和VISA）也是一項挑戰，因為針對hVISA和VISA，雖然有標準的方式可以偵測，但方法都過於昂貴且繁複，無法有效地應用在臨床大量的菌株。面對日益嚴重的抗藥性問題，除了治療本身之外，如何做好感染管制以避免這些抗藥細菌或基因的散布，以及不必要的抗生素濫用，都是刻不容緩的議題。

Staphylococcus aureus is an important causative agent of a wide variety of community and healthcare-associated infections, from local skin and soft tissue infection to deep-seated abscesses and osteomyelitis, and life-threatening septicemia and endocarditis. Methicillin-resistant S. aureus (MRSA) is a major cause of hospital-acquired infections worldwide for which glycopeptide antibiotics, including vancomycin, are the standard treatment option. S. aureus with reduced vancomycin susceptibility was first isolated in 1996. The geographic range and frequency of such isolates, which includes vancomycin-resistant S. aureus (VRSA), vancomycin-intermediate S. aureus (VISA), and heteroresistant VISA (hVISA), have increased. The prevalence of MRSA isolates with reduced vancomycin susceptibility leads to challenges in both clinical therapeutics and laboratory diagnosis because of a lack of rapid, efficient laboratory detection methods. The growing problem of antibiotic resistance can only be resolved with infection control and antimicrobial agents in order to prevent this resistance from spreading.