不动杆菌医院感染趋势及其对策

1、1会计学不动杆菌医院感染趋势及其对策不动杆菌医院感染趋势及其对策234革兰阴性杆菌革兰阴性杆菌(5702) (6502) (5152) (5089) (4805) (5515) (7101 )(9395) (9725)(11606)(15093)株株 数数不动杆菌占不动杆菌占35%37%。中国抗感染化疗杂志，中国抗感染化疗杂志，2004；4：12951994-971994-97（n=50n=50）1999-20011999-2001（n=52n=52）株株% %株株% %铜绿铜绿191920.120.1111115.315.3不动不动131314.314.3131318.618.6阴沟阴沟13

2、1314.314.35 57.17.1金葡金葡7 77.77.79 912.912.9其他其他545444.644.6323246.146.1合计合计91911001007070100100临床肺科杂志，临床肺科杂志，1998；3：29中华呼吸危重监护杂志，中华呼吸危重监护杂志，2005；4：2666701020304050607080901009920002001200220032004AMK GEN PIPCZOCECCXM CTXCAZIPM CIP AMC CSL TZP FEP 8亚胺培南耐药的鲍曼不动杆菌（协和）0 05 51 10 01 15 52 20 02 25 53 30

3、03 35 54 40 04 45 55 50 02 20 00 00 02 20 00 01 12 20 00 02 22 20 00 03 32 20 00 04 4I IR R986例亚胺培南耐药的鲍曼不动杆菌例亚胺培南耐药的鲍曼不动杆菌 耐药% I协和医院耐药监测10 0% %1 10 0% %2 20 0% %3 30 0% %4 40 0% %5 50 0% %6 60 0% %7 70 0% %8 80 0% %9 90 0% %1 10 00 0% %PiperacillinTimentinSulperazonTazocinSultamicillinCefuroximeS SI

4、 IR R86例例亚亚胺胺培培南南耐耐药药的的鲍鲍曼曼不不动动杆杆菌菌耐药%I协和医院耐药监测1086例亚胺培南耐药的鲍曼不动杆菌例亚胺培南耐药的鲍曼不动杆菌 耐药% I协和医院耐药监测150 0% %1 10 0% %2 20 0% %3 30 0% %4 40 0% %5 50 0% %6 60 0% %7 70 0% %8 80 0% %9 90 0% %1 10 00 0% %CeftazidimeCefotaximeCeftriaxoneCefepimeAztreonamMeropenemS SI IR R86例例亚亚胺胺培培南南耐耐药药的的鲍鲍曼曼不不动动杆杆菌菌耐药%I协和医院耐

5、药监测1186例亚胺培南耐药的鲍曼不动例亚胺培南耐药的鲍曼不动杆菌杆菌 耐药% I协和医院耐药监测160 0% %1 10 0% %2 20 0% %3 30 0% %4 40 0% %5 50 0% %6 60 0% %7 70 0% %8 80 0% %9 90 0% %1 10 00 0% %G Ge en nt ta am mi ic ci in nA Am mi ik ka ac ci in nC Ci ip pr ro of fl lo ox xa ac ci in nL Le ev vo of fl lo ox xa ac ci in nT TM MP PC Co oS SI I

6、R R86例例亚亚胺胺培培南南耐耐药药的的鲍鲍曼曼不不动动杆杆菌菌耐药%I协和医院耐药监测12.5087.513 - 15Doxycycline7.7092.311 - 15TMPco7.7092.316 - 20Ciprofloxacin53.823.123.115 - 16Amikacin0010013 - 14Gentamicin0010016 - 21Aztreonam0010013 - 15Cefmetazole7.7092.316 - 20Cefoperazone7.7092.315 - 17Ceftazidime0010014 - 15ImipenemS%I%R%折点药名3.80

7、96.211 - 15TMPco3.71383.314 - 16Levofloxacin3.7096.316 - 20Ciprofloxacin5.6094.415 - 16Amikacin0010016 - 21Aztreonam1.97.590.616 - 20Cefoperazone/Sulb209818 - 20Piperacillin/Tazo1.9098.115 - 17Cefepime1.9098.115 - 17Ceftazidime1.9098.114 - 15Meropenem0010014 - 15ImipenemS%I%R%折点折点药名药名14ICU11年中常用抗菌药物

8、的敏感性变年中常用抗菌药物的敏感性变迁迁1.卡巴培南保持了卡巴培南保持了10年的高敏状态年的高敏状态,但但98年、年、04年怎么啦年怎么啦?2.所有其它药所有其它药10年内敏感性下滑，模样何等相似！年内敏感性下滑，模样何等相似！共同耐药机制！共同耐药机制！S15Nosocomial Infections NTUH, Taiwan, 2004MRSA, 73.1%BSI (1942 40.6%, 20.4/1000 Dis)UTI (1471 30.7%, 15.5/1000 Dis)RTI (332 6.9%, 4.3/1000 Dis)SSI (464 9.7%, 4.1/1000 Dis)

9、%16Rate/10,000 dischargesNTUH, 1984-200418.817Susceptibility of Nosocomial Strains Susceptibility of Nosocomial Strains of Acinetobacter baumanniiof Acinetobacter baumanniiNTUH, 1986-2004%64.3%18SENTRY 1998-2002Pseudomonas spp.Acinetobacter spp.19%20DDD per 1,000 patient daysYear% of resistant isola

10、tes21Intermediate or resistant to All cephalosporins Pip/Taz, CEP/Sul Aztreonam, carbapenems Fluoroquiolones Amikacin, isepamicin, gentamicin Sulbactam (Ab)Except colistin, tigecycline(n=164)(n=167)%22NMSABPA271519151420201819221521151520202016%23亚胺培南耐药的不动杆菌（美国 ）0 05 51 10 01 15 52 20 02 25 53 30 03

11、 35 54 40 04 45 55 50 01 19 99 96 61 19 99 97 71 19 99 98 81 19 99 99 92 20 00 00 02 20 00 01 1I IR RTSN-Databas2003年韩国汉城24 敏感率（）敏感率（）IMPIMPMEPMEP意大利意大利78787777土耳其土耳其62626666英英 国国78787777其其 他他93931001009797100100 CMI 2004;10:684CMI 2004;10:684252627部门部门病例（起）病例（起）感染源及传播途感染源及传播途径径新生儿和新生儿新生儿和新生儿ICUICU1

12、29129（4 4）复苏器械、手、复苏器械、手、加湿器、肠外营加湿器、肠外营养养外科及外科外科及外科ICUICU3535（2 2）机械通气、手、机械通气、手、排风装置排风装置ICUICU219219（4 4）通风系统、复苏通风系统、复苏装置、机械通气装置、机械通气、测压传导装置、测压传导装置28293031N=159(consecutive patients who received MV for 72h)VAP caused by A. baumannii: PSB: 1000CFU/ml OR BAL: 10,000CFU/mlTrouillet, JL, et al. 1995, Abs

13、tr. A474. In Abstracts of the ATS International conference3348.597.0145.5194.0242.5291.0339.5Kb3435Distribution of the pathogens in early-onset and later-onset VAP Distribution of the pathogens in early-onset and later-onset VAP during 1999.12 to 2001.2 in SICU of Zhongshan Hospital during 1999.12 t

14、o 2001.2 in SICU of Zhongshan Hospital Pathogens Pathogens EO VAPEO VAPLO VAPLO VAPNO. of NO. of Strains Strains % %NO. of NO. of StrainsStrains% %G+ coccus G+ coccus 6 650.050.08 811.311.3Enterobacteriaceae Enterobacteriaceae 2 216.716.7191926.826.8Non-ferment Non-ferment 2 216.716.7292940.840.8 A.

15、BaumA.Baum1 18.38.3121216.916.9FungusFungus1 18.38.33 34.24.2totaltotal1212100100717110010036Analysis of the homology of the colonized route in 2 groupsAnalysis of the homology of the colonized route in 2 groupsGroupsGroupsTotalTotalComplete Complete identical identical 1-3 1-3 different different s

16、traps in straps in DNADNA3 3 different different straps in straps in DNADNAGroup 1Group 1131312121 10 0Group 2Group 23 32 20 01 1Group 1:stomach-pharynx oralis-low respiratory tract; group Group 1:stomach-pharynx oralis-low respiratory tract; group 2: stomach-low respiratory tract2: stomach-low resp

17、iratory tract37Table 3 Distribution of the pathogens in 15 VAP casesTable 3 Distribution of the pathogens in 15 VAP casesBacteriaBacteriaNO. of strainsNO. of strainsRatio Ratio EscherichiaEscherichia coli coli 3 320.020.0KlebsiellaKlebsiella pneumoniae pneumoniae 2 213.313.3EnterobacterEnterobacter

18、cloacae cloacae 1 16.76.7SerratiaSerratia marcescens marcescens 2 213.313.3ProteusProteus mirabilis mirabilis 1 16.76.7AcinetobacterAcinetobacter baumannii baumannii 3 320.020.0PseudomonasPseudomonas aeruginosa aeruginosa 1 16.76.7Bacterium alkalescens Bacterium alkalescens 1 16.76.7Candida albicans

19、 Candida albicans 1 16.66.6Total Total 1515100.0100.038PFGE of 3 A.baum strains3940Infected or Infected or colonized casescolonized casesMatched Matched controlscontrolsNo. of No. of pairspairsp Valuep ValueLength of stay Length of stay (days)(days)41.5241.5213.9213.921021020.0010.001No. of antibiot

20、icsNo. of antibiotics7.427.422.382.381021020.0010.001ICU daysICU days27.3527.355.535.531021020.0010.001Patients on Patients on ventilatorventilator616125251021020.0010.0578疗程结束时疗程结束时第第3030天随访天随访CPZ/SBTCPZ/SBTIMP/CSTIMP/CSTCPZ/SBTCPZ/SBTIMP/CSTIMP/CST清除清除2525191911111414假定清假定清除除1 12 20 00 0部分清部分清除除1

21、11 10 01 1替换替换0 01 10 00 0持续持续1 14 44 43 3无法评无法评价价3 33 30 00 0清除率清除率80.680.675.075.073.373.382.482.4两组细菌学疗效比较两组细菌学疗效比较P均均0.0579CPZ/SBTCPZ/SBTIMP/CSTIMP/CST铜绿假单孢菌铜绿假单孢菌10/14(71.4%)10/14(71.4%)14/21(66.7%)14/21(66.7%)# #不动杆菌不动杆菌11/14(78.6%)11/14(78.6%)8/17(47.1%)8/17(47.1%)* *其他假单孢菌其他假单孢菌1/21/20 0嗜麦芽窄食单孢嗜麦芽窄食单孢菌菌1/11/10 0产碱杆菌产碱杆菌1/11/11/11/1其他其他1/21/20 0# P=0.533 *P=0.077808182谢谢 谢！谢！83SENTRY 1998-2002Pseudomonas sp