浅谈抗菌药物的临床应用2012-4-9.ppt

浅谈抗菌药物的临床应用,lijiabin948,内容,细菌耐药机制抗菌药物滥用的后果细菌耐药性监测抗菌药物的分级管理抗菌药物的临床应用,2,细菌耐药机制,3,内容,细菌耐药机制抗菌药物滥用的后果细菌耐药性监测抗菌药物的分级管理抗菌药物的临床应用,4,细菌耐药性的产生；二重感染；副作用。,抗菌药物滥用的后果,5,内容,细菌耐药机制抗菌药物滥用的后果细菌耐药性监测抗菌药物的分级管理抗菌药物的临床应用,6,随着抗菌药物在临床上的广泛使用，细菌耐药率呈上升趋势，为了了解我省细菌耐药情况，为临床合理用药提供参考，在2011年9月随机抽取了我省不同地区医院临床分离的细菌2200株进行耐药监测，具体报道如下:,7,350株革兰阳性球菌的分布（2011年）,8,MR比例（CHINET数据）,9,2011年肠杆菌科细菌分布示意图,10,2011年葡萄糖非发酵细菌分布示意图,11,我省处于前六位的革兰阴性菌与革兰阳性菌,大肠埃希菌克雷伯菌属铜绿假单胞菌不动杆菌阴沟肠杆菌嗜麦芽窄食单胞菌,金黄色葡萄球菌表皮葡萄球菌溶血性葡萄球菌粪肠球菌屎肠球菌链球菌属,12,SpeciesDistributionofGNBCausingIAIs2,292Isolates,China,SMART,2002-2007,13,金黄色葡萄球菌对抗菌药物的敏感率,14,表皮葡萄球菌对抗菌药物的敏感率,15,溶血性葡萄球菌对抗菌药物的敏感率,16,粪肠球菌对抗菌药物的敏感率,17,屎肠球菌对抗菌药物的敏感率,18,1.TsiodrasS,etal.LinezolidresistanceinaclinicalisolateofStaphylococcusaureus.Lancet2001;358:207-208.2.PillaiSK,etal.LinezolidResistanceinStaphylococcusaureus:CharacterizationandStabilityofResistantPhenotype.JID2002;186:1603-1607.3.PeetersMJ,SarriaJC.Clinicalcharacteristicsoflinezolid-resistantStaphylococcusaureusinfections.AmJMedSci2005;330(2):102-4.4.RobertsSM,etal.Linezolid-resistantStaphylococcusaureusintwopediatricpatientsreceivinglow-doselinezolidtherapy.PediatrInfectDisJ2006;25(6):562-4.5.BrauersJ,etal.SurveillanceoflinezolidresistanceinGermany,2001-2002.ClinMicrobiolInfect2005;11(1):39-46.6.WongA,etal.PolyphyleticEmergenceofLinezolid-ResistantStaphylococciintheUnitedStates.AntimicrobialAgentsandChemotherapy2010;54(2):742-748.7.EndimianiA,BlackfordM,DasenbrookEC,etal.EmergenceofLinezolid-ResistantStaphylococcusaureusafterProlongedTreatmentofCysticFibrosisPatientsinCleveland,Ohio.AntimicrobialAgentsandChemotherapy2011;55(4):1684-16922.8.HentschkeM,etal.EmergenceofLinezolidResistanceinaMethicillinResistantStaphylococcusaureusStrain.Infection2008;36(1):85-87.9.GalesAC,etal.Emergenceoflinezolid-resistantStaphylococcusaureusduringtreatmentofpulmonaryinfectioninapatientwithcysticfibrosis.InternationalJournalofAntimicrobialAgents2006;27:300-302.10.Ikeda-DantsujiY,etal.Linezolid-resistantStaphylococcusaureusisolatedfrom2006through2008atsixhospitalsinJapan.JInfectChemother2011;17:45-51.11.SanchezGarcaM,etal.ClinicalOutbreakofLinezolid-ResistantStaphylococcusaureusinanIntensiveCareUnit.JAMA2010;303(22):2260-2264.12.YoshidaK,etal.Linezolid-resistantmethicillin-resistantStaphylococcusaureusisolatedafterlong-term,repeateduseoflinezolid.JInfectChemother2009;15(6):417-9.13.HillRL,etal.Linezolid-resistantST36methicillin-resistantStaphylococcusaureusassociatedwithprolongedlinezolidtreatmentintwopaediatriccysticfibrosispatients.JAntimicrobChemother2010;65:442-445.14.HongSB.Co-emergenceoflinezolid-resistantStaphylococcusaureusandEnterococcusFaeciuminapatientwithmethicillin-resistantS.aureuspneumonicsepsis.DiagnosticMicrobiologyandInfectiousDisease2011;69:232-233.15.MoralesG,PicazoJJ,BaosE,etal.ResistancetoLinezolidIsMediatedbythecfrGeneintheFirstReportofanOutbreakofLinezolid-ResistantStaphylococcusaureus.ClinicalInfectiousDiseases2010;50:821-825.16.中日友好医院病原菌资料：甲氧西林耐药金黄色葡萄球菌药敏分析(2010.9-2011.2).,单一抑菌机制药物利奈唑胺的耐药报道不断,LRSA=耐利奈唑胺金葡菌,19,万古霉素在脑脊液中可达有效治疗浓度,RybakM,etal.Therapeuticmonitoringofvancomycininadultpatients:AconsensusreviewoftheAmericanSocietyofHealth-SystemPharmacists,theInfectiousDiseasesSocietyofAmerica,andtheSocietyofInfectiousDiseasesPharmacists.AmJHealth-SystPharm2009;66:82-98.,有炎症时，万古霉素在脑脊液的浓度达6.4-11.1mg/L，远高于常见致病菌MIC90值,20,万古霉素的肺组织浓度显著达到足够的治疗浓度,GaryE.Stein,etal.Theimportanceoftissuepenetrationinachievingsuccessfulantimicrobialtreatmentofnosocomialpneumoniaandcomplicatedskinandsoft-tissueinfectionscausedbymethicillin-resistantStaphylococcusaureus:vancomycinandlinezolid,CurrentMedicalResearch34(11):2256-2259.,舒巴坦对不动杆菌有