スタフィロコーカス・オーレウス・バクテレミアの臨床管理: レビュー
Thomas L Holland1, Christopher Arnold2, Vance G Fowler1
1Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, North Carolina2Duke Clinical Research Institute, Duke University, Durham, North Carolina.
JAMA
|October 1, 2014
まとめ
トランスエゾファゲアルエコーカルディオグラフィーは,Staphylococcus aureus bacteremiaの患者全員に推奨されます. 特定の低リスク要因は回避することが可能であり,ヴァンコマイシンまたはダプトマイシンはMRSAバクテレミアに好ましい.
科学分野:
- 感染症 感染症は感染症です.
- 心臓病学 心臓病学
- 薬理学 薬理学とは
背景:
- Staphylococcus aureus bacteremia (SAB) の管理には,効果的な戦略が必要である.
- メチシリン耐性S. aureus (MRSA) 細菌症に対するトランスエゾファゲアルエコーカルディオグラフィ (TEE) と最適な抗生物質療法が必要かどうかを決定することは,非常に重要です.
研究 の 目的:
- SABの経営戦略に関する証拠をレビューする.
- 成人のSAB症例におけるTEEの役割を評価する.
- MRSAバクテレミアの最適な抗生物質治療法を特定するために.
主な方法:
- PubMed,EMBASE,およびコクラン図書館 (2014年5月設立) の体系的な文献検索.
- TEEに関する研究をSABに含め,MRSAバクテレミアに対する抗生物質療法.
- 推薦,評価,開発,評価のグレード (GRADE) を用いて評価された証拠の品質.
主要な成果:
- SABにおけるTEEの使用は,トランストラシックエコーカルディオグラフィー (2% -15%) と比較して,より高い心内炎診断率 (14% -28%) と関連していました.
- SAB患者のTEEを潜在的に回避するために特定された特定の低リスク要因.
- バンコマイシンとダプトマイシンは,MRSAバクテレミアの治療に類似した有効性を示しました.
結論:
- エコーカルディオグラフィーは,S. aureus bacteremiaを患っているすべての成人の患者に推奨されます.
- SABにおけるTEEを回避するための低リスク患者の特徴が特定されています.
- バンコマイシンとダプトマイシンは,MRSAバクテレミアに対する第一線薬として推奨されます.
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