CLSI三代头孢菌素折点改变南京讲座(修)课件.ppt

1、2010年年CLSI对头孢菌素类的对头孢菌素类的折点改变及其临床意义折点改变及其临床意义 zhu_zhu_对头孢菌素类折点改变的临床意义对头孢菌素类折点改变的临床意义 zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_目前我国的临床微生物实验室均以CLSI文件作为药敏试验指导文件进行操作和报告 zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ 拉氧头孢拉氧头孢 zhu_zhu_ zhu_zhu_ 除肠杆菌科细菌之外的其他细菌均未进行头孢菌素的折点改变！zhu_zh

2、u_ zhu_zhu_*对金葡菌和路登葡萄球菌同时进行对金葡菌和路登葡萄球菌同时进行FOX和和OXA药敏时，药敏时，两者只要有一个结果显示耐药就应该报告苯唑西林耐药两者只要有一个结果显示耐药就应该报告苯唑西林耐药 zhu_zhu_ zhu_zhu_ zhu_zhu_BreakpointInterpretive StandardCLSI对头孢菌素类折点改变的临床意义对头孢菌素类折点改变的临床意义 zhu_zhu_ zhu_zhu_Predictors of Bacterial Eradication:Pharmacokinetic/Pharmacodynamic profilesPenicill

3、insPenicillinsCephalosporinsCephalosporinsCarbapenemsCarbapenemsQuinolonesQuinolonesAminoglycosidesAminoglycosidesMacrolidesMacrolidesTelithromycinTelithromycinDoxycyclineDoxycyclineTime MICMIC40-50%AUC24/MICMIC25-125 zhu_zhu_*0.75gQ8H zhu_zhu_DrugDosage CommentCefazolinBreakpoints are based on a do

4、sage regimen of at least 1 g every 8 h.CefepimeBreakpoints are based on a dosage regimen of 1 g every 8 h or 2 g every 12 hCefotaxime or ceftriaxoneBreakpoints are based on a dosage regimen of 1 g every 24 h for ceftriaxone and 1 g every 8 h for cefotaximeCefuroxime(parental)Breakpoints are based on

5、 a dosage regimen of 1.5 g q8 h.CeftazidimeBreakpoints are based on a dosage regimen of 1 g every 8 h.CeftizoximeBreakpoints are based on a dosage regimen of 1 g every 12 h.AztreonamBreakpoints are based on a dosage regimen of 1 g every 8 h.zhu_zhu_ Patient characteristics Age,sex,body mass,pharmaco

6、kinetics,immune status,underlying disease Infection characteristics Type of infection,site of infection,the stage of he infection,presence of foreign material,vascularisation,oxygenation.Bug characteristics Species,pharmacodynamics,microbiological susceptibility,presence of and type of resistance me

7、chanisms.Likelihood of clinical success and failure is related to many variables zhu_zhu_ zhu_zhu_ zhu_zhu_13296株肠杆菌科细菌头孢噻肟纸片法药敏株肠杆菌科细菌头孢噻肟纸片法药敏 抑菌圈直径的分布抑菌圈直径的分布2008年中国年中国CHINET资料资料使用新折点使肠杆菌科细菌对头孢噻肟的耐药率提高了使用新折点使肠杆菌科细菌对头孢噻肟的耐药率提高了CLSI2009CLSI2010S=45.7%I=10.6%R=43.7%R=54.3%I=4.3%S=41.1%zhu_zhu_6678株大

8、肠埃希菌头孢噻肟纸片法药敏 抑菌圈直径的分布52.6%9.7%37.7%62.3%62.3%2.2%35.5%CLSI2009CLSI20102008年中国年中国CHINET资料资料使用新折点使大肠埃希菌对头孢噻肟的耐药率提高了使用新折点使大肠埃希菌对头孢噻肟的耐药率提高了 zhu_zhu_2009CLSI2010CLSI 3752株产ESBL大肠埃希菌头孢噻肟纸片法 药敏抑菌圈直径的分布S=0.8%S=1.4%I=0.5%R=98.6%I=11.4%R=87.3%2008年中国年中国CHINET资料资料使用新折点使产使用新折点使产ESBLs大肠埃希菌对头孢噻肟的耐药率提高了大肠埃希菌对头孢噻肟的耐药率提高了 zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ 才能指示临床治疗有效！才能指示临床治疗有效！zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_ zhu_zhu_