ManagementofMRSAInfectionsinAdultPatients：在成人患者MRSA感染的管理.pptVIP

Performance measures are included at the end of the guidelines: The management of all MRSA infections should include identification, elimination, and/or debridement of the primary source and other sites of infection when possible. In patients with MRSA bacteremia, clearance of bacteremia should be documented with follow-up blood cultures performed 2-4 days after the initial positive culture and as needed thereafter. Vancomycin should be dosed according to actual body weight (15-20 mg/kg/dose every 8-12 hours), not to exceed 2 grams per dose. Trough monitoring is recommended to achieve target concentrations of 15-20 μg/mL in patients with serious MRSA infections and to ensure target concentrations in those who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution. When an alternative to vancomycin is being considered, in vitro susceptibility should be confirmed and documented in the medical record. For MSSA infections, a ?-lactam antibiotic is the drug of choice in the absence of allergy. There were two studies where patients were randomized to receive either vancomycin or linezolid + aztreonam for the treatment of nosocomial pneumonia. In these two studies, there was no difference in the clinical cure rates, no difference in microbiologic success rates or in the eradication rates of MRSA. In a subsequent posthoc subgroup analysis of that looked at all patients with MRSA in both studies, those patients assigned to the vancomycin arm had lower rates of clinical cure and survival compared to linezolid. Due to limitations of this post hoc analysis, the guidelines assigned both vancomycin and linezolid AII level recommendations. These recommendations will be re-evaluated pending publication of the results of the ZEPHYr paper which compared vancomycin vs. linezolid head to head in a randomized controlled trial of patients with MRSA pneumonia. Daptomycin should not be used for treatment of pneumonia as it is inactivated by pulmonary s