抗生素(英文精品) Multi-drug resistant pathogens(67p)幻灯片课件.pptVIP

25% of E. coli ESBL (3% Europe, 79 % India, 50% Egypt, 22% Thailand) Antibiotic use not predictive except for ciprofloxacin 5/21 persistently colonized 156 pts affected 35% of kitchen surfaces colonized 6 of 44 (14%) of food workers fecal carriers 2 y.o. from China Adopted Secondary transmission in family Modified Hodge Test Lawn of E. coli ATCC 25922 1:10 dilution of a 0.5 McFarland suspension Imipenem disk Test isolates Described by Lee et al. CMI, 7, 88-102. 2001. Which is more dangerous? Resistance in gram-positive organisms 1990 1997 2000 PRSP 4% 30-50% 48% VTSP 0.2% 3.6-5.1% MRSA 20-25% 25-50% GISA 0 0.1 0.1 VRE 0.1 15 21 Evolution of E. faecium resistance MIC90 of E. faecium 1968 1969-88 1989-90 Penicillin 8 64 512 Ampicillin 2 32 128 % VRE 0 0 61% Grayson et al, AAC Community acquired (ca-) MRSA strains generally CANNOT be distinguished from hospital acquired strains by the presence of: MEC-A gene SCC pattern Panton-Valentine leukocidin Why is this different? Outbreaks in new populations Different disease spectrum (boils, CAP) Spider bite history Specific clones SCCmec type IV Panton-Valentine Leukocidin (PVL) Susceptible to many antibiotics Populations with ca-MRSA Children Inmates Military recruits Native populations MSM HIV+ patients Religious communities Football teams Wrestlers Gymnasts Fencing teams IDU Homeless Disease Syndrome Skin/soft tissue (non-Trauma) Abscess Cellulitis Folliculitis Other/Unknown Wound (Traumatic) Urinary Tract Infection Sinusitis Bacteremia Pneumonia Osteomyelitis Septic arthritis Bursitis No. (%) 1, 266 (77%) 751 (59%) 528 (42%) 88 ( 7%) 212 (17%) 157 (10%) 64 ( 4%) 61 ( 4%) 43 ( 3%) 31 ( 2%) 21 ( 2%) 15 ( 1%) 19 ( 1%) Clinically Relevant CA-MRSA Disease (GA/MD/MN n=1,674, 78%)  Fridkin et al. NEJM, 2005 MRSA skin