耐药GNB感染抗菌治疗__培训课件.pptxVIP

耐药革兰阴性菌感染的抗菌治疗 Gram-negative bacilli account for over 70% of all clinical isolates in ChinaPercentage of Gram-negative bacilli in total clinical isolates (%)CHINET 2015Gram-positive cocci30％（26481/88778）Gram-negative bacilli70％（62297/88778）CHINET national bacterial resistance surveillance data革兰阴性菌的构成CHINET 2007-2014Constituent ratio of A. baumannii, P. aeruginosa and K. pneumoniae among all clinical isolates in China since 2005K. pneumoniae%A. baumanniiP. aeruginosaCHINET national bacterial resistance surveillance dataHu FP, Clin Microbiol Infect 2016; 22: S9–S14Corelation of increasing trends of imipenem-resistance with constituent ratio of K. pneumoniae clinical isolates in China since 2005CHINET DATAConstituent ratioRatio%CR%Imipenem-resistance rateModified from Hu FP, Clin Microbiol Infect 2016; 22: S9–S14Corelation of increasing trends of imipenem-resistance with constituent ratio of A. baumannii clinical isolates in China since 2005Imipenem-resistance rateCHINET DATARatio%CR%Constituent ratioModified from Hu FP, Clin Microbiol Infect 2016; 22: S9–S14Corelation of increasing trends of imipenem-resistance with constituent ratio of P. aeruginosa clinical isolates in China since 2005CHINET DATARatio%CR%Imipenem-resistance rateConstituent ratioModified from Hu FP, Clin Microbiol Infect 2016; 22: S9–S14A report of bacterial resistance in China 2005~2014Antimicrobial resistance in five most common bacteria: E. coli, K. pneumoniae, A. baumannii, P. aeruginosa and S. aureusHu FP, Clin Microbiol Infect 2016; 22: S9–S14主题词MDR、XDR、PDR的定义MDR--Multiple-drug resistant, 多重耐药：对3类或以上在抗菌谱范围内的抗菌药耐药XDR--Extensively drug resistant, 广泛耐药：除1-2个抗菌药敏感外，均耐药PDR--Pan-drug resistant，全（泛）耐药：对当前临床应用的所有抗菌药耐药Magiorakos AP, Clin Microbiol Infect 2012,18: 268OUTLINE肠杆菌科细菌老问题：产ESBL新问题：产碳青霉烯酶非发酵糖细菌习惯了的问题：XDR鲍曼不动杆菌变化不大的问题：铜绿假单胞菌嗜麦芽窄食单胞菌肠杆菌科细菌耐药问题： 最需关注的β-内酰胺酶是ESBLs?超广谱β-内酰胺酶(ESBLs)?高产头孢菌素酶(AmpC酶)?产碳青霉烯酶（KPC、NDM-1等） MDRXDR orPDRPrevalence of ESBL in Enterobacteracae肠杆菌科细菌ESBL检出率CHINET Data 产与非产ESBL