MRSA 感染治疗抗MRSA治疗的几个临床问题????经验性治疗还是靶向治疗？经验性治疗的指征是什么？利奈唑胺临床试验结果的解读临床如何实践MRSA防控？金葡菌耐药的变迁青霉素金葡菌1940s青霉素耐药金葡菌1950s甲氧西林甲氧西林耐药金葡菌(MRSA)1960s，1970s1959万古霉素2019万古霉素耐(药)量(MBC/MIC)2019万古霉素耐药金葡菌(VRSA)20002019万古霉素中耐金葡菌(VISA)1990s万古霉素耐药肠球菌(VRE)斯沃利奈唑胺耐药金葡菌的发展医院获得性感染中见到的抗生素耐药金葡菌的发展也可见于社区获得性感染，两者有相似的趋势医院获得性感染社区获得性感染Penicillinase-producing S aureus100100Methicillin-resistant S aureusResistant isolates (%)75Resistant isolates (%)196019802000755025502501940Year019401960Year19802000McDonald LC. Clin Infect Dis. 2019;42:S65-S71.HCA感染和HA感染的病原学相似肺炎1HAHCA(n=835)(n=988)菌血症2HA(n=468)HCA (n=3705)菌血症3HAHCAa(n=370)b (n=234) bMSSA (%)26212018811MRSA (%)23318276251023853629475肺炎链球菌(%)假单胞菌属(%)克雷伯菌属(%)埃希氏菌属(%)7585676201511924MRSA = methicillin-resistant Staphylococcus aureus; MSSA = methicillin-susceptible S aureus;HA = hospital-acquired; HCA = healthcare-associated; CA = community-acquired.1.2.3.Kollef M, et al. Chest. 2019;128:3854-3862. Shorr AF, et al. Crit Care Med. 2019;34:2588-2595. Siegman-Igra YS, et al. Clin Infect Dis. 2019;34:1431-1439.MRSA感染的危害? MRSA感染可能–增加死亡风险1–增加患病率2,3–延长住院时间2,3–增加住院费用1,2,4死亡率相关性比较5：MRSA vs MSSA研究MSSA:methicillin-sensitive staphylococcus aureus1. Rubin RJ, et al. Emerg Infect Dis. 2019;5:9-17.2. Carbon C. J Antimicrob Chemother. 2019;44(suppl A):31-36.3. The Brooklyn Antibiotic Resistance Task Force. Infect Control Hosp Epidemiol. 2019;23:106-108.4. Abramson MA et al. Infect Control Hosp Epidemiol. 2019;20:408-411.5. Cosgrove SE et al. Clin Infect Dis. 2019;36:53-59.比值比不恰当抗菌治疗的相关因素? 出现，或先前暴露于，耐药菌感染1,2–先前使用抗生素3,4–先前使用侵袭性装置1–长期...
