碳青霉烯暴露后的抗生素选择策略分析.pptVIP

* * Bacteria can acquire resistance through a mutation or by acquisition of new DNA via conjugation, transduction, or transformation. For each of these processes, transposons or integrons may facilitate the transfer and incorporation of the multiple resistant genes into the host’s genome or plasmids. In conjugation, plasmids are transferred via sex pili and both the donor and the recipient end up with a copy of the plasmid. Conjugation can occur in a broad range of bacterial species and resistance to multiple drugs may be transferred. In transduction, bacterial resistance genes of plasmid or chromosomal origin are carried from one bacteria to another by bacteriophages. Bacteriophages have a narrow host range and are less effective in disseminating resistance in a bacterial population. IN transformation, bacterial pick up DNA from their environment, such as after cell lysis. Transposons can relocate from one are of the bacterial chromosome to another or to a plasmid or bacteriophage resulting in even wider dissemination of resistant genes. * * 各类证据提示ESKAPE的出现都与碳青霉烯类抗生素的使用密切相关。虽然碳青霉烯类抗生素仍保持对肠杆菌科细菌最强的抗菌活性、最高的敏感性，但是鉴于碳青霉烯暴露后对医院生态、个体生态的影响，应当在初始治疗、替换治疗时充分评估致病菌及耐药性，做到合理使用碳青霉烯、减少碳青霉烯耐药菌的产生。 E:屎肠球菌；S:金黄色葡萄球菌；K:肺炎克雷伯菌；A:鲍曼不动杆菌；P:铜绿假单胞菌；E:肠杆菌属 * * By some estimates, half of all hospitalized patients receive an antibiotic and 50% of antibiotic use may be inappropriate. The potential consequences of inappropriate us include toxicity, antimicrobial resistance, other HAI such as C. difficile colitis, increased morbidity and mortality, prolonged LOS, and increased costs. Antimicrobial resistance is no longer confined to the hospital. MRSA has recently emerged as an important cause of infections outside of hospitals. Community-acquired MRSA is now the leading cause of identifiable skin and soft tissue infections seen in U.S. emergency departments. Changes in antimicrobial use are paralleled by changes in the prevalence of antimicrobial resistance. Bacterial resistance will