(精选)细菌耐药性(英文课件)Antimicrobial Resistance教学课件.pptVIP

THE U.S. MEDICINE INSTITUTE FOR HEALTH STUDIESAddressing Antimicrobial ResistanceWashington, DCFebruary 9, 2007Donald M. Poretz, MD, FACP, FIDSA Planet Earth Microbes Human Beings Number 5 x 1031 6 x 109 Metric Tons 5 x 1016 3 x 108 Replicate 20-30 minutes 20-30 years Microbiology in the 21st century: Where are we and where are we going? Washington, DC. American Society for Microbiology;2004. Microbes Have had 3.5 billion years to adapt to the environment Have invented both beta-lactam antibiotics and beta-lactamase enzymes to resist those antibiotics more than 2 billion years ago Have had collective experience creating and defeating antibiotics for 20 million times longer than Homo sapiens have known antibiotics existed Do not need our help in creating antibiotic resistance Human Beings Can affect the rate of spread of bacterial resistance by applying selective pressure via exposure to the thousands of metric tons of antibiotics we have used in patients and livestock over the last half century Underlying Principles of Antibiotic Resistance Given sufficient time and drug use, antibiotic resistance will emerge. There are no antibiotics to which resistance has not eventually appeared (PRSP took 25 years) Resistance is progressively evolving from low levels through intermediate to high levels (Increasing MICs are a marker for future resistance) Levy, S. NEJM 1998; 338 (19):1376-8 Underlying Principles of Antibiotic Resistance The use of antibiotics by any one person affects others in the extended as well as immediate environment (Housemates of patients treated with antibiotics for acne had large numbers of drug- R flora on their skin) Levy, S. NEJM 1998; 338 (19):1376-8 Underlying Principles of Antibiotic Resistance Organisms that are resistant to one drug are likely to become resistant to others (Fluoroquinolones have resistance em