常見耐藥細(xì)菌感染的治療課件

常見耐藥細(xì)菌感染的防治(Treatmentofdrug-resistantBacterialInfection)黃仕聰重慶醫(yī)科大學(xué)第一附屬院呼吸科DRUGRESISTANCE抵御耐藥性今天不行動(dòng)明天感染治療沒保障oactiontoday.nocuretomorrowWorldHealthWorldHealthDay2019Organization011年世界衛(wèi)生日抗感染藥物耐藥的定義多重耐藥:MDR;廣泛耐藥:XDR全耐藥?:PDRTABLE6.Definitionsformultidrug-resistant(MDR),extensivelydrug-resistant(XDR)andpandrug-resistant(PDR)bacteriaBacteriumStaphyLococcIaureusTheisolateisnon-susceptibletoatleastIagentTheisolateisnon-susceptibletoatleastIagentinallin23antimicrobialcategorleslistedinTableIbut2orfewerantmicrobialcategoriesinTEtimiarobalcategoriesEnterococussTheisolateisnon-susceptibletoatleastIagentTheisolateisnon-susceptibletoatleastIagenteachbacteriuninin23antimicrobialcategorieslistedinTable2but2orfewerantimicrobialcategoriesinTable2EnterobacteriaceaeThesolateisnon-susceptibletoatleastIagentTheisolateisnon-susceptibletoatleastIagentinallin23antimicrobialcategorieslistednTable3but2orfewerantimicrobialcategoriesinTable3.PseudomonasaeruginosaTheisolateisnon-susceptibletoatleastIagentTheisolateisnon-susceptibletoatleastIagentinallin23antimicrobialcategorieslistedinTable4but2orfewerantimicrobialcategoriesinTable4Acinetobacterspp.Theisolateisnon-susceptibletoatleastIagentTheisolateisnon-suscepubletoatleastIagentinallin23antimicrobialcategorieslistedinTable55.AllMRSAisolatesaredefinedasMDrbecauseresistancetooxacillinorcefoxitinpredictsnon-susceptiblitytoallcategoriesoff-lactamantimicrobiallstedhoCU-ent,withtheexceptionoftheanti-MRSAcephalosporins(ie.allategoriesofpenicillins,cephalosporins,B-Lactamaseinhibitorsandcarbapenemscurrentlyapptil25january2019).hctp//wwwwecdceuropaeu'enacovioesdseaseprogrammes/ARHAIPages/pubic_conskation_clinicaL_microbiology_infection_articleaspx全球范圍內(nèi),“ESKAPE”耐藥已成為導(dǎo)致患者發(fā)病及死亡的重要原因nterococcusfaecium(屎腸球菌)taphylococcusaureus(金黃色葡萄球菌)klebsiellapneumoniae(肺炎克雷伯菌)cinetobacterbaumannii鮑氏不動(dòng)桿菌seudomonasaeruginosa(銅綠假單胞菌)nterobacterspecies(腸桿菌ESKAPEESKAPE在美國,IDSA與美國國會(huì)、FDA、國家健康耐藥菌感染協(xié)會(huì)、CDC及其它組織對(duì)"ESKAPE耐藥問題病死率高給予了極大關(guān)注目前治療“'ESKAPE耐藥菌感染的藥物在療效安全性等方面仍存在眾多顧慮;此外,新藥的上市速率亦在顯著減慢,我們可應(yīng)用的新型抗菌藥物在逐漸減少ESKAPE加患者負(fù)擔(dān)革蘭陽性球菌的耐藥性上升■G耐藥性最突出是甲氧西林耐藥葡萄球菌(MRSA和MRSE)萬古霉素耐藥葡萄球菌(VISA、VRSA)青霉素不敏感肺炎鏈球菌(PISP\PRSP)■萬古霉素耐藥腸球菌(VRE)葡萄球菌感染葡萄球菌屬(Staphylococcus)KunkelMicroscopy,inc.yDennisKunke最常見的化膿性球菌醫(yī)院內(nèi)交叉感染的重要傳染源堆積、排列成葡萄串狀分布廣泛分布于哺乳動(dòng)物和鳥的皮膚和粘膜,條件致病菌所致疾病侵襲性疾病局部感染:如皮膚粘膜、各組織器官的的化膿性炎癥、肺炎全身感染:如敗血癥、膿毒血癥、心內(nèi)膜炎na:lormung,毒素性疾病4,Extaoernfection(scaledskinsyndrome)GaleormyelrBoilsinfectionofhairfolliclesbyS.aureusAbscess膿皰病ImpetigoSchoolsores:commonmostlyamongchildrenOsteomyelitis金葡菌耐