念珠菌诊治指南（温州）课件.ppt

念珠菌流行病学趋势与IDSA2009年念珠菌治疗指南 江苏省人民医院 周苏明 2011年2月27日 Epidemiology of candidemia in intensive care units International Journal of Antimicrobial Agents 32 Suppl. 2 (2008) S87–S91 Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: A multicenter, prospective, observational study in France (2005–2006) (Crit Care Med 2009; 37:1612–1618) One hundred eighty ICUs in France. Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection. 107 (39.5%) patients with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, 77 (28.4%) with invasive candidiasis and candidemia. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. 中国5所医院念珠菌属对氟康唑和伏立康唑的耐药性监测ARTEMIS 朱德妹 张婴元 汪复中国感染与化疗杂志，2007,7(1):14~18 80 00株念珠菌和酵母菌分别来自北京、杭州、广州和上海5所三级甲等医院临床微生物实验室和真菌室临床分离株 Candida Albicans Versus Non-Albicans Intensive Care Unit-Acquired Bloodstream Infections: Differences in Risk Factors and Outcome ANESTHESIA ANALGESIA Vol. 106, No. 2, February 2008 The most important independent conditions predisposing to candidemia in ICU patients include: prior abdominal surgery, intravascular catheters, acute renal failure, parenteral nutrition, broad-spectrum antibiotics, a prolonged ICU stay, the use of corticosteroids and mucosal colonization with Candida. Molecular basis of resistance to azole antifungalsTRENDS in Molecular Medicine Vol.8 No.2 February 2002 唑类药物在细胞内的浓度降低： 泵出机制：over-expressing ABC-type efflux pumps, (over-expressing both CDR1 and CDR2) ---- Candida albicans, Candida glabrata Overexpression of CDR1 and CDR2 in C. albicansis associated with cross-resistance to the azoles, and amorolfine 唑类药物在细胞内的作用靶点水平增高 唑类药物的作用靶点是细胞色素P450，后者由EGR11（或CYP51）编码 In the case of a clinical isolate of C. glabrata cross-resistance to fluconazole, itracon