CLSI三代頭孢菌素折點改變及其臨床意義

1、1會計學(xué)CLSI三代頭孢菌素折點改變及其臨床意三代頭孢菌素折點改變及其臨床意義義目前我國的臨床微生物實驗室均以CLSI文件作為藥敏試驗指導(dǎo)文件進(jìn)行操作和報告 拉氧頭孢拉氧頭孢 南南 “S”結(jié)果改成結(jié)果改成“R” 除腸桿菌科細(xì)菌之外的其他細(xì)菌均未進(jìn)行頭孢菌素的折點改變！*對金葡菌和路登葡萄球菌同時進(jìn)行對金葡菌和路登葡萄球菌同時進(jìn)行FOX和和OXA藥敏藥敏時，兩者只要有一個結(jié)果顯示耐藥就應(yīng)該報告苯唑時，兩者只要有一個結(jié)果顯示耐藥就應(yīng)該報告苯唑西林耐藥西林耐藥BreakpointInterpretive StandardCLSI對頭孢菌素類折點改變的臨床意對頭孢菌素類折點改變的臨床意義義Quinol

2、onesQuinolonesAminoglycosidesAminoglycosidesMacrolidesMacrolidesTelithromycinTelithromycinDoxycyclineDoxycyclineTime MICMIC40-50%AUC24/MICMIC25-125*0.75gQ8HDrugDosage CommentCefazolinBreakpoints are based on a dosage regimen of at least 1 g every 8 h.CefepimeBreakpoints are based on a dosage regimen

3、 of 1 g every 8 h or 2 g every 12 hCefotaxime or ceftriaxoneBreakpoints are based on a dosage regimen of 1 g every 24 h for ceftriaxone and 1 g every 8 h for cefotaximeCefuroxime (parental)Breakpoints are based on a dosage regimen of 1.5 g q8 h.CeftazidimeBreakpoints are based on a dosage regimen of

4、 1 g every 8 h.CeftizoximeBreakpoints are based on a dosage regimen of 1 g every 12 h.AztreonamBreakpoints are based on a dosage regimen of 1 g every 8 h.nPatient characteristicsnAge, sex, body mass, pharmacokinetics, immune status, underlying diseasenInfection characteristicsnType of infection, sit

5、e of infection, the stage of he infection, presence of foreign material, vascularisation, oxygenation .nBug characteristics nSpecies, pharmacodynamics, microbiological susceptibility, presence of and type of resistance mechanisms .Likelihood of clinical success and failure is related to many variabl

6、es13296株腸桿菌科細(xì)菌頭孢噻肟紙片法株腸桿菌科細(xì)菌頭孢噻肟紙片法藥敏藥敏 抑菌圈直徑的分布抑菌圈直徑的分布2008年中國年中國CHINET資料資料使用新折點使腸桿菌科細(xì)菌對頭孢噻肟的耐藥率提使用新折點使腸桿菌科細(xì)菌對頭孢噻肟的耐藥率提高了高了CLSI2009CLSI2010S=45.7%I=10.6%R=43.7%R=54.3%I=4.3%S=41.1%6678株大腸埃希菌頭孢噻肟紙片法藥敏 抑菌圈直徑的分布52.6%9.7%37.7%62.3%62.3%2.2%35.5%CLSI2009CLSI20102008年中國年中國CHINET資料資料使用新折點使大腸埃希菌對頭孢噻肟的耐藥率提高使用新折點使大腸埃希菌對頭孢噻肟的耐藥率提高了了2009CLSI2010CLSI 3752株產(chǎn)ESBL大腸埃希菌頭孢噻肟紙片法 藥敏抑菌圈直徑的分布S=0.8%S= 1.4%I=0.5%R=98.6%I=11.4%R=87.3%2008年中國年中國CHINET資料資料使用新折點使產(chǎn)使用新折點使產(chǎn)ESBLs大腸埃希菌對頭孢噻肟的耐藥率大腸埃希菌對頭孢噻肟的耐藥率提高了提高了 才能指示臨床治療有