作者pharmawind (Compulsive Disorder P't)
看板pharmacist
標題金黃色葡萄球菌與抗生素的聖戰
時間Wed Nov 2 13:43:36 2011
金黃色葡萄球菌與抗生素的聖戰 (The War of the S. aureus & Antibiotics)
圖文好讀版:
http://pharmawind.pixnet.net/blog/post/36066957
金黃色葡萄球菌 (Staphylococcus aureus, S. aureus) 對人類來說是一個重要的
病原體。從歷史的角度來看,S. aureus 的侵入性感染總是造成很高的死亡率。
Staphylococcus aureus is an important human pathogen. Historically,
invasive infections have been associated with very high mortality rates.
在
磺胺類藥物還沒問世的1933-1936年代
(pre-sulfonamide period),感染
S. aureus 所造成之菌血症病人的死亡率超過四分之三 (median 79%, range 56-89%)
(Arch Intern Med 1939; 63:1068–1083)。1937-1941年,因將磺胺藥導入治療而讓死
亡率降至 40%
(Arch Intern Med 1941; 67:25–35)。
During the pre-sulfonamide period, 1933–1936, over three-quarters
(median 79%, range 56–89%) of patients with bacteraemic S. aureus infection
died [1]. The introduction of the sulfonamide agents, 1937–1941, reduced
these high mortality rates to 40% [2].
Penicillin 在 1942-1947 年以橫空出世之姿,將 S. aureus 菌血症感染之死亡率
將至 28%;然而,S. aureus 也在短期內強勢反擊,並在 1948-1953 將死亡率再度提升
至 45-50%
(Arch Intern Med 1954; 94:167–196)。
The introduction of penicillin, 1942–1947, reduced the S. aureus
bacteraemia death rate to 28%; however, the rise of penicillin resistance
shortly thereafter, 1948–1953, was associated with higher mortalities of the
order of 45–50% [3].
1962 年
methicillin 殺出救援,成功地在這場戰爭中幫助抗生素陣營重拾優勢,
並將死亡率降至 25%。然而,俗諺有云:「道高一尺,魔高一丈」。幾乎就在 methi-
cillin 救援的同時,S. aureus 也進化成更兇殘的
methicillin-resistant S. aureus
(MRSA),在死亡率表現方面,即便將許多共伴因素納入分析後仍可發現,MRSA 特種部
隊比
methicillin-susceptible S. aureus (MSSA) 傳統部隊還要十惡不赦 (OR 1.93,
95% CI 1.54–2.42, P<0.001)
(Clin Infect Dis 2003; 36:53–59)。
After the introduction of methicillin in 1962, the mortality rates
decreased again to approximately 25% [52]. Almost as soon as methicillin was
introduced, MRSA was being reported [53]. Patients with MRSA bloodstream
infections have a greater mortality risk than those with methicillin-
susceptible S. aureus (MSSA) bacteraemia (OR 1.93, 95% CI 1.54–2.42,
P<0.001), even accounting for confounding variables such as the presence or
absence of central venous access devices, endocarditis, bacteraemia during
an outbreak, and severity of underlying illness [4].
雖然時至今日,萬古神兵 -
vancomycin 仍然是對 MRSA 的首選武器,但 MRSA 對
vancomycin 的敏感性日益降低已經成為大家高度關注的問題,MRSA 再一次超進化成
vancomycin-intermediate S. aureus (VISA) 與
vancomycin-resistant S. aureus
(VRSA),也將死亡率推向另一個高峰 (63%)
(Clin Infect Dis 2003; 36:429–439)。
More recently, concern has been expressed regarding the identification of
MRSA strains with reduced susceptibility to vancomycin,
vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus,
that have been associated with higher bacteraemia-related mortality rates
(63%) [5].
隨著超世代神兵陸續的誕生,以及 S. aureus 不斷的進化,這場以人體為戰場的
兵燹征戎,將永無停戰的一天。
超世代神兵 - Linezolid
超世代神兵 - Quinupristim/Dalfopristin
超世代神兵 - Tigecycline
超世代神兵 - Daptomycin
超世代神兵 - Telavancin
超世代神兵 - Ceftaroline
Reference:
[1] Mendell TH. Staphylococcal septicemia: a review of thirty-five cases,
with six recoveries, twenty-nine deaths, and sixteen autopsies. Arch
Intern Med 1939; 63:1068–1083.
[2] Spink WW, Hansen AE, Paine JR. Staphylococcal bacteremia, treatment
with sulfapyridine and sulfathiazole. Arch Intern Med 1941; 67:25–35
[3] Spink WW. Staphylococcal infections and the problem of antibiotic-
resistant Staphylococci. Arch Intern Med 1954; 94:167–196.
[4] Cosgrove SE, Sakoulas G, Perencevich EN, et al. Comparison of mortality
associated with methicillin-resistant and methicillin-susceptible
Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;
36:53–59.
[5] Fridkin SK, Hageman J, McDougal LK, et al. Epidemiological and micro-
biological characterization of infections caused by Staphylococcus
aureus with reduced susceptibility to vancomycin, United States,
1997–2001. Clin Infect Dis 2003; 36:429–439.
--
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有錢有車有房
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♂ 歡 男生
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推 lavenderess:好文! 11/02 14:13
推 sdbb:快推,以免人家說我看不懂 11/02 15:38
推 DM1984:有看有推XD 11/02 15:41
→ pharmawind:我寫的很口語很搞笑 看不懂請別見怪XD 11/02 16:25
推 Abyss:強者 11/02 20:09
推 BestYoung:文筆不錯啊,應該醫藥相關人員都看得津津有味吧! @_@ 11/02 21:33
推 stvene:數碼寶貝化 XD 11/03 10:28
推 HTTRE:好文必推ㄧㄧ 11/05 07:19
推 MikeFreeway:我笑了,好文推XDy 11/05 20:59
推 leafleft:推~期待其他系列XD 11/06 15:10
推 MikeFreeway:唉....開始脫節了啊.....Orz 11/07 11:36
推 virgil010030:好文值得按1,淺顯易懂 11/07 16:26
推 lovelyours:我笑了 學長推XD 11/09 23:54
推 gysample:好文 11/27 11:13