细菌耐药现状及耐药变迁课件.ppt

1、Adapted with permission from Kollef MH et al.Chest 1999;115:462-474.医院死亡率医院死亡率(%)不恰当治疗不恰当治疗 恰当治疗恰当治疗p0.001p 65岁岁的的病病人人从从美美国国3555急急诊诊单单位位入入选选 医医院院内内死死亡亡率率为为10.3%，其其中中30天天死死亡亡率率为为15.3%30天天死死亡亡的的相相关关因因素素：延延迟迟8h给给药药：OR为为0.85，95%CI（0.750.96）Time of initial antibioticMeehan et.al.,JAMA 1997;278:2080-2084诊

2、断后给予抗生素的时间（h）校正的30天死亡率OR值（95%CI）证据证据In vitro susceptibility of 14 antibiotic agents against 371 strains of E.coliAntibiotic name%R%I%SMIC50MIC90 Geom.MeanMIC RangeCefoxitin19.710.869.58328.573.125-512Cefoperazone/Sulbactam9.416.474.18325.137.06-256Ceftriaxone35.821.342.9322563.962.016-512Cefotaxime/

3、Clavulanic 1.11.397.60.0640.50.102.016-128Cefotaxime34.219.746.1162564.077.016-512Ceftazidime15.44.380.31321.293.016-256Ceftazidime/Clavulanic 1.60.597.50.1250.50.224.032-128Cefepime14.61075.52321.019.008-128Imipenem001000.1250.250.133.064-2Meropenem001000.0160.0640.02.008-.5Ciprofloxacin76.31.122.6

4、326410.272.004-128Levofloxacin72.23.82416326.827.008-128 对对FQs 的耐药率高达的耐药率高达 70%对对3-4代头孢菌素耐药机制几乎全为代头孢菌素耐药机制几乎全为ESBLs 其中头孢吡肟其中头孢吡肟头孢他啶保持了高效头孢他啶保持了高效371株大肠杆菌株大肠杆菌1.细菌对亚胺培南、美罗培南的耐药率1%2.头孢吡肟和头孢他啶的耐药率相仿 3.两种复方制剂的耐药率10%4.对环丙沙星的耐药率高In vitro susceptibility of 12 antibiotic agents against 317 strains of K.pne

5、umoniaeAntibiotic name%R%I%SMIC50MIC90 MIC RangeCefoxitin18.9675.14128 1-512Cefoperazone/Sulbactam15.11173.8464.016-512Piperacillin/Tazobactam8.53.887.7432.125-512Ceftriaxone26.512.361.20.125128.016-512Cefotaxime/Clavulanic acid1.93.894.30.0644.016-256Cefotaxime19.61763.40.125128.016-512Ceftazidime1

6、9.63.5770.5256.016-512Ceftazidime/Clavulanic acid8.50.690.90.254.032-512Cefepime9.18.582.30.12516.008-512Imipenem001000.1250.25.064-4Meropenem001000.0320.064.008-2Ciprofloxacin36.33.260.60.2564.004-64Levofloxacin37.51.960.60.564.016-64肺克菌中有一种酶，占8.5%主要破坏头孢他啶，克拉维酸不能水解它，1.细菌对亚胺培南、美罗培南的耐药率1%2.头孢吡肟的耐药率低于

7、头孢他啶，和两种复方制剂相仿，耐药率26%3.对环丙沙星的耐药率有增高趋势1.ESBL 的检出率逐年上升 2.大肠ESBL的检出率高于克雷伯ESBL的检出率实验室数正在逐年上升3.不仅局限在大肠、克雷伯菌属，还在肠杆菌属、枸橼酸菌属和变形杆菌属中均有发现中国ESBLs明显的地区差别 王辉，陈民钧等 中华医学杂志 2003;83(5):385)In vitro susceptibility of 10 antibiotic agents against 318 strains of P.aeruginosaAntibiotic name%R%I%SMIC50MIC90MIC RangeCefop

8、erazone/Sulbactam23.917.358.81664.125-256Ceftazidime35.5559.44256.064-512Cefepime26.115.758.28128.016-512Imipenem20.84.774.5216.125-512Meropenem1110.778.3116.016-256Ciprofloxacin28.37.564.20.516.016-64Levofloxacin28.96.964.2116.064-64Gatifloxacin28.311.360.4216.064-64Amikacin232.274.84256.125-512Pol

9、ymixin B4.4095.622.25-128绿脓杆菌 1.细菌对亚胺培南、美罗培南的耐药率在上升，耐药率20%；2.对头孢吡肟、头孢哌酮/舒巴坦的耐药率约为13%；3.对头孢他啶等抗菌药物的耐药率约20%左右In vitro susceptibility of 11 antibiotic agents against 242 strains of A.baumannii Antibiotic name%R%I%SMIC50MIC90MIC RangeCefoperazone/Sulbactam11.231.457.41664.125-256Ceftazidime54.57.43864 G

10、256.016-512Cefepime47.912.439.716256.032-512Imipenem16.93.379.8116.125-256Meropenem17.47.475.2116.016-128Ciprofloxacin58.72.139.31664.032-128Levofloxacin44.212.843416.032-32Gatifloxacin45.511.643416.002-64Amikacin51.21.247.564 G256.125-512Polymixin B2.1097.911.25-128Minocycline22.721.955.4416.125-64

11、鲍曼不动杆菌1.细菌对亚胺培南、美罗培南的耐药率在上升，04年前为4.2%-5.7%，06年达15.5%-16.7%；2.对头孢哌酮/舒巴坦的耐药率为10.5%；3.对头孢他啶等抗菌药物的耐药率约40%-50%；In vitro susceptibility of 12 antibiotic agents against 57 strains of B.cepeciaeAntibiotic name%R%I%SMIC50MIC90MIC RangeCefoperazone/Sulbactam42.122.835.1321281-256Ceftazidime38.65.356.181281-51

12、2Cefepime56.121.122.832642-512Imipenem56.11429.816 G256.125-512Meropenem33.35.361.44128.032-256Ciprofloxacin66.715.817.5864.25-64Levofloxacin33.321.145.6432.125-64Gatifloxacin49.112.338.6416.5-64Amikacin87.75.37256 G2562-512Polymixin B91.208.8128128.5-128Trimethoprim/smz50.9049.14256.064-512Minocycline715.877.248.25-256*如遇到泛耐药株要进行粘菌素和多粘菌素B的MIC测定 增加的品种*只有稀释法标准，没有纸片法结果判断标准*如米诺环素、多烯环素等59”63