挑战超级细菌课件.ppt
1,挑战“超级细菌” 延缓细菌耐药,今天不采取行动，明天无药可用,全球关注的多重耐药菌,MRSAVRE产ESBL的肠杆菌科菌产NDM-1,KPC,IMP,VIM等的肠杆菌科菌CR ABA,MRSA在中国大陆：CHINET 2009,汪复等. 2009年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2010; 10(5):325-334.,Regional Trends in MRSA Rates (SENTRY Program, 1997-2008; GPRS,2005-2009),抗生素的耐药发展史，新药迅速耐药值得重视,Clatworthy AE, et al. Targeting virulence: a new paradigm for antimicrobial therapy. Nature chemical biology 2007; 3(9):541-548.,2006-2009年监测数据 耐万古霉素的粪肠球菌与屎肠球菌发生率极少,细菌耐药率 (%),20061CHINET (N=2621),20072CHINET (N=2634),20084CHINET (N=2859),2006-20073MOH (N=7528),1. 汪复. 2006年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2008; 8(1):1-9.2. 汪复等. 2007年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2008; 8(5):325-333.3. 肖永红等. 2006-2007年Mohnarin细菌耐药检测. 中华医院感染学杂志 2008; 18(8):1051-1056.4. 汪复等. 2008年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2009; 9(5):321-329. 5. 汪复等. 2009年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2010; 10(5):325-334.,20095CHINET (N=3369),2006-2007年5月9株VRE共分为6个克隆（A型-F型），为多克隆传播，其中VRE2、VRE8和VRE9同属于A型，VRE3和VRE4同属于B型。,王贺 徐英春 等 中国医学科学院学报，2008；30（5）：521-524,The clinical information, genotype of 9 isolates (2006-2007年5月),王贺 徐英春 等 中国医学科学院学报，2008；30（5）：521-524,全球关注的多重耐药菌,MRSAVRE产ESBL的肠杆菌科菌产NDM-1,KPC,IMP,VIM等的肠杆菌科菌CR ABA,E. coli ESBL APAC region (SENTRY),Farrell DJ, et al., J Infection (2010);60:440-51,SMART：产ESBLs菌感染的临床和经济学结果,设计: 在腹腔感染 (IAI) 住院患者中进行一项回顾性研究场所: 中国参与SMART的6家机构方法: 通过微生物学分析确定所有产ESBLs分离株和抗生素敏感性主要目标: 回顾性评价感染产ESBLs菌的住院患者中感染缓解和卫生保健资源使用情况,Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010, 14431449,ESBLs患者起始抗生素治疗成功率较低,0,20,40,60,80,100,百分比,82%,58%,起始抗生素的 治疗成功率2,b,P=0.016,ESBLs (+),ESBLs (-),n=54 n=31,主要研究目标是回顾性评价感染产ESBL菌的住院患者中感染缓解和卫生保健资源使用情况。ESBLs阳性组和 ESBLs阴性组患者的起始抗生素治疗成功率分别为 58.1% (18/31)和 81.5%(44/54),Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010, 14431449,ESBLs患者住院时间延长,0,5,10,15,20,25,天数,14.5,24.5,住院时间,P0.001,ESBLs (+),ESBLs (-),n=54 n=31,Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010, 14431449,ESBLs患者治疗费用增加,人民币(元),ESBLs (+),ESBLs (-),P=0.052,P=0.004,总住院费用,静脉用抗生素的费用,15217.5,21498.4,1869.9,4320.2,n=54 n=31,n=51 n=26,Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010, 14431449,人民币(元),15,16,How about SMART global currently?,Approaching 200 sites in 58 countriesAsia/Pacific: 54Europe: 53Latin America: 38North America: 28MEA: 25Each site to collect 100 IAI and 50 UTI each year25-30,000 isolates per year added to database of 70,000,17,SMART China _ 10 years history,Hospital list of SMART China,The distribution of isolates from IAI in China from 2002-2009,49.2%,66.1%,Yang et al. International Journal of Antimicrobial Agents 36 (2010) 507512,Results : Increase of ESBL_E.Coli/K. Pneunoniae in China (IAI) from 2002 to 2009,Yang et al. International Journal of Antimicrobial Agents 36 (2010) 507512,% ESBL-Producing E. coli SMART, 2002-2009, IAI, ChinaCommunity Onset vs. Hospital Onset,Qiwen yang，yingchun xu etal，international J antimicrob Agents ，2010,36:507-512,23,Results 3: Trends in the susceptibility of Enterobacteriaceae in China from 2002 to 2009,Yang et al. International Journal of Antimicrobial Agents 36 (2010) 507512,24,SMART Asia-Pacific Map,25,ESBL-producing E.Coli/K.Pneumoniae in IAI are common, especially in China and India,1/3,1/4,P.-R. Hsueh et al. / International Journal of Antimicrobial Agents 36 (2010) 408414,26,The susceptibility of EPM 、IMP and PTZ to isolates of IAI is high in AP (2008),P.-R. Hsueh et al. / International Journal of Antimicrobial Agents 36 (2010) 408414,ESBL/AmpC+ 孔通道缺失,产IMP4/8菌株,产KPC-2菌株,碳青霉烯耐药肠杆菌科地域分布(2004-2008),What other drugs can we test if isolate is “R” to all drugs that might be used for Enterobacteriaceae?,黏菌素 /多粘菌素 敏感MIC 2 g/ml S 替加环素 可能敏感 MIC 2 g/ml S,52,Genetic characteristics of blaKPC-2-carrying K. pneumoniae from China during 2009 SENTRY Program,Yao Wang1, Lalitagauri M. Deshpande2, Rodrigo E. Mendes2, YunSong Yu3, Yingchun Xu1, Minjun Chen1, David J. Farrell2, Ronald N. Jones21Peking Union Medical College Hospital, Beijing, China2JMI Laboratories, North Liberty, IA, USA3 The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China,Results,9 isolates (5.5%) from 10 sites with elevated imipenem and/or meropenem MICs (2 g/ml)6 isolates from Hangzhou were MHT positive and blaKPC positive.Sequence: KPC-2 encoding gene,PFGE and MLST,PFGE: SpeI digestionClone A: 4 isolates with 3 subtybes (ICU)-ST 11Clone B: 2 isloates (neurological ward)-ST 65,SEANIR2008：大肠埃希菌和肺炎克雷伯菌的药物敏感性,注：头孢噻利仅测试大肠埃希菌和肺炎克雷伯菌各68株。,头孢塞利与其他药物联合或单药的抑菌效果,赵颖，徐英春等，中国感染与化疗杂志 待发表,头孢塞利与其他药物联合抑菌效果,赵颖，徐英春等，中国感染与化疗杂志 2011待发表,联合用药：,铜绿假单胞菌折点与给药剂量信息,CLSI M100-S21. 2011,寻找新的酶抑制剂： NXL104,NXL104 is a novel -lactamase inhibitor that inhibits AmpC, as well as ESBL and KPC enzymesBeing studied in combination with both ceftaroline and ceftazidime,新酶抑制剂+新头孢菌素Ceftaroline with NXL104,Sader HS, et al. IDSA 2010; poster 214,结论,MRSA：中国有下降的趋势 万古霉素+头孢塞利联合有较高的相加作用VRE：平均发生率较低E.Coli和K. pneumoniae：腹腔感染分离率高，且产ESBL菌株快速增长，三四代头孢菌素敏感率持续下降 、但避免过量使用碳青霉烯类，体外敏感可选头孢塞利，头孢他啶，哌拉西林-他唑巴坦，头孢哌酮-舒巴坦，头孢美唑铜绿假单胞菌：折点与计量，或联合有较高的协同与相加作用 碳青霉烯类耐药的菌株发生率平均较低，注意医院感染控制：隔离间医护洗手含氯消毒液消毒环境护理员及探访家属洗手,39,谢谢！,
