MRSA抗菌治疗进展.ppt

* * MRSA is a big problems in our hospital. The prevalence of MRSA causing nosocomial infections increased from 20% to 40% in early 1990s to 80% in 2002. Although we have screened vancomycin resistance for more than five thousand isolates of MRSA, no VISA or VRSA or vancomycin hetero-resistance was found. Indeed, some strain of VISA confirmed by Professor Hiramatsu were found in other hospital in Taiwan. * As part of the SENTRY Antimicrobial Surveillance Program, 1,562 bacterial isolates were recovered from hospitalized patients with skin and soft tissue infections (SSTIs) in 30 United States and 8 Canadian medical centers between October and December 1997. This slide lists the 6 most common bacteria recovered. 在治疗耐药的革兰阳性菌的抗生素中,目前主要有3大类,传统的时万古霉素(包括替考拉宁), 利奈唑胺和达托霉素,几类产品各有特点,然而从杀菌类型来看达托霉素是快速杀菌剂. * * 美国FDA向利奈唑胺发出警告：在治疗导管相关感染的三期临床研究表明，利奈唑胺治疗首次用药84天后，死亡率高达21.5%，远远高于对照组16.0% LEADER耐药监测项目覆盖美国56个医疗中心大型监测平台。 从监测结果可见，单一的抑菌机制使利奈唑胺耐药率从2004－2009年逐年上升。 Farrell DJ, et al. LEADER Program Results for 2009: an Activity and Spectrum Analysis of Linezolid Using 6,414 Clinical Isolates from 56 Medical Centers in the United States. Antimicrobial agents andchemotherapy 2011; 55(8):3684-3690. 上述所有利奈唑胺耐药的患者中，单药使用万古霉素治疗LRSA感染，患者的存活率为100%，单药使用替加环素治疗，患者的存活率为60%, * Mechanical ventilation, No. (%) 115 (66.9) 130 (73.9) Bacteremia, No. (%) 9 (5.2) 20 (10.8) * * * MDRSP refers to isolates resistant to 2 or more of the following antibiotics: penicillin, second-generation cephalosporins, macrolides, tetracycline, and trimethoprim/sulfamethoxazole. * MDRSP refers to isolates resistant to 2 or more of the following antibiotics: penicillin, second-generation cephalosporins, macrolides, tetracycline, and trimethoprim/sulfamethoxazole. * MDRSP refers to isolates resistant to 2 or more of the following antibiotics: penicillin, second-generation cephalosporins, macrolides, tetracycline, and trimethoprim/sulfamethoxazole. * MDRSP refers to isolates resistant to 2 or more of the following antibiotic