美國感染症醫學會Methicillin抗藥性金黃色葡萄球菌治療指引

Treatment Guidelines for Infections Caused by Methicillin-Resistant Staphylococcus aureus

美國感染症醫學會(IDSA)於2011年發佈了新的methicillin抗藥性金黃色葡萄球菌(methicillin-resistant Staphylococcus aureus; MRSA)治療指引 (practice guidelines)，針對日漸嚴重的社區型MRSA感染與醫療照護相關 MRSA感染治療選擇提出建議，此指引依不同感染部位區分，同時針對成人與兒 童MRSA感染的治療有明確的說明。作者取得IDSA同意，節譯供相關臨床人員參考。本指引之重點包括：不是所有MRSA感染都需要使用抗生素，對於簡單的膿腫或膿瘡，切開引流即可，並不需要使用抗生素治療。皮膚表淺感染可透過局部抗生素塗抹治療治癒。治療MRSA感染應包括找出感染源，並除去主要來源和其他可能感染部位（如膿腫引流、移除中央靜脈導管、清創骨髓炎等）。教育所有皮膚與軟組織感染患者保持個人衛生和進行適當的傷口護理。MRSA菌血症患者，於初次血液培養陽性2～4天後應積極再做血液培養，以證實菌血症已被控制。成人vancomycin的劑量應根據實際體重給予（15~20 mg/kg/dose q8-12h，每次劑量不應超過2g)，已不建議測量vancomycin高峰濃度，只測最低濃度即可，理想的vancomycin最低濃度應維持在15~20μg/mL。當要選擇vancomycin以外的抗生素治療時，必須確認菌株對抗生素敏感性試驗的結果，並記錄在病歷中。

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of both health care-associated and community-associated infections. In Taiwan, approximately 80% and 50% of Staphylococcus aureus infections are caused by MRSA in health care settings and communities, respectively. Therefore, treatment of MRSA infection is an important issue. In January 2011, the Infectious Diseases Society of America (IDSA) published the first guidelines on the treatment of MRSA infections. The guidelines provide recommendations on a variety of clinical signs associated with MRSA infections, including skin and soft tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections, among adults and children. They also address issues related to the use of vancomycin in the treatment of MRSA infections, including dosing and monitoring, current limitations of susceptibility testing, and the use of alternate therapies for those patients in whom the vancomycin failed to give the desired outcome and in whom infection resulted due to strains with reduced susceptibility to vancomycin. Having gained permission from the IDSA, we intend to translate the clinical practice guidelines into a Chinese edition, which can provide our physicians with recommendations on the management of MRSA infections.