(精编)【医学精品课件之抗生素】多耐药非发酵菌感染的治疗现状及展望教学课件.pptVIP

几种联合方案对7株MDR铜绿假单胞菌的体外效应 All seven strains were resistant to piperacillin, meropenem,ceftazidime, cefoperazone–sulbactam , aztreonam, amikacin, and ciprofloxacin Bacteriostatic effects, any decrease in viable count from the starting inoculum; synergic effects, ≥2 log10 cfu/mL decrease between the combination and its most active single component; bactericidal effects, ≥3 log10 cfu/mL decrease in the starting inoculum. Journal of Antimicrobial Chemotherapy (2003) 52, 911–914 In vitro activities of IPM/sulb combination against carbapenem-resistant A. baumannii Journal of Antimicrobial Chemotherapy (2007) 60, 317–322 多耐药非发酵菌感染的治疗现状及展望 解放军总医院 佘丹阳 dysheh@ MRSA E. coli and Klebsiella species Acinetobacter baumannii Aspergillus VRE P. aeruginosa Bad Bugs, No Drugs: List of Dangerous Bugs 2006 . 2006 E nterococcus faecium S taphylococcus aureus K lebsiella pneumoniae A cinetobacter baumannii P seudomonas aeruginosa E nterobacter Boucher HW, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. CID 2009;48:1-12. Bad Bugs, No Drugs，No ESKAPE: List of Dangerous Bugs 2009 非发酵菌感染的治疗：天然耐药的抗菌药物 Arch. Immunol. Ther. Exp., 2006, 54, 113–120 铜绿假单胞菌感染的传统治疗方案 β-内酰胺类+氨基甙类 碳青霉烯类+氨基甙类 哌拉西林/他唑巴坦+氨基甙类 头孢哌酮/舒巴坦+氨基甙类 头孢他啶+氨基甙类 头孢吡肟+氨基甙类 氨曲南+氨基甙类 β-内酰胺类+喹诺酮类 碳青霉烯类+ +CIP或LVF 哌拉西林/他唑巴坦+CIP或LVF 头孢哌酮/舒巴坦+ +CIP或LVF 头孢他啶+ CIP或LVF 头孢吡肟+ CIP或LVF 氨曲南+ CIP或LVF Combination Antimicrobial Therapy Decreases Mortality for Pseudomonas aeruginosa Bacteremia Safdar et al Lancet ID 2004; 4:519-27 5 studies looked at Pseudomonas bacteramia Combination therapy had a 50% survival benefit In the largest study, most of monotherapy was with aminoglycosides MDR革兰阴性菌导致的难治性VAP的治疗：联合治疗 vs 单药治疗 Crit Care Med 2008； 36：737-44 不动杆菌感染的传统治疗药物 β-内酰胺类抗生素 碳青霉烯类 亚胺培南 美洛培南 含舒巴坦的β-内酰胺/酶抑制剂复合物 氨苄西林/舒巴坦 头孢哌酮/舒巴坦 非β-内酰胺类药物 氟喹诺酮类药物 氨基甙类药物 四环素类药物 利福霉素类药物 非发酵菌耐药性快速发展：临床治疗面临前所未有的困难！！！ Bad Bugs, No Drugs Prevalence of MDR among P. aeruginosa strains in various parts of the world AAC. 2008, 52