摘要

金黄色葡萄球菌是重要的人类病原体，负责社区和医疗机构的感染。虽然许多关注焦点集中在耐甲氧西林的“变种”MRSA上，但甲氧西林敏感对应物（MSSA）仍然是感染的主要物种。金黄色葡萄球菌尤其是MRSA的流行病学表现出近年来的快速发展。在代表典型的医院内多药耐药性病原体后，MRSA最近出现在社区和养殖动物之中，这归功于其能够进化并适应不同环境。全球监测表明，MRSA在所有大陆和已开展研究的国家都是一个问题，它决定了死亡率的增加以及使用后期资源昂贵的抗生素的需求。金黄色葡萄球菌可以很容易地获得对抗生素的抗性，MRSA的特征是多药耐药性。耐万古霉素，主要抗MRSA抗生素很少见，尽管易感性降低的菌株在许多地区得以恢复。已出现抵抗最近引入的抗生素，利奈唑胺和达托霉素的作用;然而，他们对MSSA和MRSA的绝大多数仍然保持活跃。较新的抗葡萄球菌药物已经开发出来，但是由于迄今为止它们的临床用途非常有限，所以对抗性的出现知之甚少。分子分型技术已经允许鉴定MSSA和MRSA的主要成功克隆和谱系，包括高风险克隆，并追踪它们的扩散。面对不断演变的情景，本评论描述了目前流行于不同地理区域和不同环境的最常见克隆。由于金黄色葡萄球菌的进化将会持续下去，因此在全球范围内保持对金黄色葡萄球菌流行病学的关注是非常重要的。

Staphylococcus aureus is an important human pathogen, responsible for infections in the community and the healthcare setting. Although much of the attention is focused on the methicillin-resistant “variant” MRSA, the methicillin-susceptible counterpart (MSSA) remains a prime species in infections. The epidemiology of S. aureus, especially of MRSA, showed a rapid evolution in the last years. After representing a typical nosocomial multidrug-resistant pathogen, MRSA has recently emerged in the community and among farmed animals thanks to its ability to evolve and adapt to different settings. Global surveillance has shown that MRSA represents a problem in all continents and countries where studies have been carried out, determining an increase in mortality and the need to use last-resource expensive antibiotics. S. aureus can easily acquire resistance to antibiotics and MRSA is characteristically multidrug resistant. Resistance to vancomycin, the principal anti-MRSA antibiotic is rare, although isolates with decreased susceptibility are recovered in many areas. Resistance to the more recently introduced antibiotics, linezolid and daptomycin, has emerged; however, they remain substantially active against the large majority of MSSA and MRSA. Newer antistaphylococcal drugs have been developed, but since their clinical use has been very limited so far, little is known about the emergence of resistance. Molecular typing techniques have allowed to identify the major successful clones and lineages of MSSA and MRSA, including high-risk clones, and to trace their diffusion. In the face of a continuously evolving scenario, this review depicts the most common clones circulating in different geographical areas and in different settings at present. Since the evolution of S. aureus will continue, it is important to maintain the attention on the epidemiology of S. aureus in the future with a global view.

https://link.springer.com/chapter/10.1007%2F82_2016_3