产ESBLs肠杆菌科细菌感染的治疗课件

产ESBLS肠杆菌科细菌感染的治疗浙江大学医学院附属邵逸夫医院感染科俞云松产ESBLS肠杆菌科细菌感染的治疗1社区革兰阴性菌感染肠杆菌科细菌>70%PSeudomonasaeruginosa口Proteusmirai1is□Indo1aStenotrophomonasmaltophiliaAntimicrobAgentsChemother.2019Jan;50(1):374-8社区革兰阴性菌感染肠杆菌科细菌2医院革兰阴性菌感染肠杆菌科细菌50%-60%94.9797.4310090807060非发酵菌40口肠杆菌科细菌302010201920192019浙江大学医学院附属那逸夫医院CHINET20192019医院革兰阴性菌感染肠杆菌科细3肠杆菌科细菌最需关注的β内酰胺酶是ESBLSESBLS是肠杆菌科细菌最重要的耐药机制超广谱β-内酰胺酶(ESBLS)高产头孢菌素酶(Ampc酶)L>MDR极少数菌株产碳青霉烯酶XDRor碳青霉烯酶KPC)PDR肠杆菌科细菌4超广谱β-内酰胺酶(extendedspectrumβlactamases,ESBLS)是一类由质粒介导的2be类β内酰胺酶,能水解氧亚氨基β内酰胺抗生素,大多数能被β内酰胺酶抑制剂如克拉维酸(CA)所抑制。+NHRcOOCH头孢噻肟、头孢他啶、头孢吡肟等超广谱β-内酰胺酶(extendedspectrumβ5CommonESBLproducers:ESBLsarerarein.KlebsiellapneumoniaePseudomonasaeruginosa·EscherichiacoliProteusmirabilisAcinetobacterbaumannEnterobactercloacaeNon-typhoidalPER-typeandOXA-typeSalmonella(insomeenzymesaremorecommonInPseudomonaseruginosaandcountries)AcinetobactersppFirstdescribedinGermany(1983)andFrance(1985)amongKlebsiellasppCommonESBL6社区获得感染ESBLs流行情况HenanBeijingShanghai1.2019-2019年Zhejiang2.中国7个地区Wuhanlong3.社区获得性感染病人分离的革兰Guangzu阴性菌共209社区获得感染ESBLs流行情况7肠杆菌科细菌产ESBLSVAllEcoliKlebsiellaEnterobacter(1651)(953)357)CitrobacterSerratia(175)ESBL16?imipenemErtapenem00000000Cefotaxime14.714.415425.1Ceftazidime(59)(2,7)(8.1)20.0Pip/taz9.57.113221.7Ciprofloxacin40.850.625.222.9AntimicrobAgentsChemother.2019Jan:50(1):374-8.肠杆菌科细菌产ESBLSV8ESBLS-anemergingproblemGlasswelletalHealthcare-associatedInfectionandAntimicrobialResistanceDeptAntimicrobialResistanceMonitoringandReferenceLaboratory,HealthProtectionAgency,Colindale,LondonFigure7-NumberoflaboratoriesinEnglandthatdetectedESBL-ProducingEcoliduring2019and200Communitypatentscer’Yboc0CTypeofSample:Blood(UrineESBLS-anemergingproblem9SpeciesDistributionofGNBCausingTAIs2.292Isolates,China.SMART2019-2019口EscherichiacoliaKlebsiellapneumoniaePSeudomonasaeruginosaDEnterobactercloacaeACinetobacterbaumannii口Citrobacterfreundi口Stenotrophomonasmaltophilia口others11%49%SpeciesDistributionofGNBCa10产ESBLs肠杆菌科细菌感染的治疗课件11产ESBLs肠杆菌科细菌感染的治疗课件12产ESBLs肠杆菌科细菌感染的治疗课件13产ESBLs肠杆菌科细菌感染的治疗课件14产ESBLs肠杆菌科细菌感染的治疗课件15产ESBLs肠杆菌科细菌感染的治疗课件16产ESBLs肠杆菌科细菌感染的治疗课件17产ESBLs肠杆菌科细菌感染的治疗课件18产ESBLs肠杆菌科细菌感染的治疗课件19产ESBLs肠杆菌科细菌感染的治疗课件20产ESBLs肠杆菌科细菌感染的治疗课件21产ESBLs肠杆菌科细菌感染的治疗课件22产ESBLs肠杆菌科细菌感染的治疗课件23产ESBLs肠杆菌科细菌感染的治疗课件24产ESBLs肠杆菌科细菌感染的治疗课件25产ESBLs肠杆菌科细菌感染的治疗课件26产ESBLs肠杆菌科细菌感染的治疗课件27产ESBLs肠杆菌科细菌感染的治疗课件28产ESBLs肠杆菌科细菌感染的治疗课件29产ESBLs肠杆菌科细菌感染的治疗课件30产ESBLs肠杆菌科细菌感染的治疗课件31产ESBLs肠杆菌科细菌感染的治疗课件32产ESBLs肠杆菌科细菌感染的治疗课件33产ESBLs肠杆菌科细菌感染的治疗课件34产ESBLs肠杆菌科细菌感染的治疗课件35产ESBLs肠杆菌科细菌感染的治疗课件36产ESBLs肠杆菌科细菌感染的治疗课件37产ESBLs肠杆菌科细菌感染的治疗课件38产ESBLs肠杆菌科细菌感染的治疗课件39产ESBLs肠杆菌科细菌感染的治疗课件40产ESBLs肠杆菌科细菌感染的治疗课件41产ESBLs肠杆菌科细菌感染的治疗课件42产ESBLs肠杆菌科细菌感染的治疗课件43产ESBLs肠杆菌科细菌感染的治疗课件44产ESBLs肠杆菌科细菌感染的治疗课件45产ESBLs肠杆菌科细菌感染的治疗课件46产ESBLs肠杆菌科细菌感染的治疗课件47产ESBLs肠杆菌科细菌感染的治疗课件48产ESBLs肠杆菌科细菌感染的治疗课件49产ESBLs肠杆菌科细菌感染的治疗课件50产ESBLs肠杆菌科细菌感染的治疗课件51产ESBLs肠杆菌科细菌感染的治疗课件52产ESBLs肠杆菌科细菌感染的治疗课件53产ESBLs肠杆菌科细菌感染的治疗课件54产ESBLs肠杆菌科细菌感染的治疗课件55产ESBLs肠杆菌科细菌感染的治疗课件56产ESBLs肠杆菌科细菌感染的治疗课件57产ESBLs肠杆菌科细菌感染的治疗课件58产ESBLs肠杆菌科细菌感染的治疗课件59产ESBLs肠杆