20140525鲍曼不动杆菌流行及治疗(俞云松)课件.ppt

High-dose ampicillin-sulbactam for MDRAB VAP Scand J Infect Dis 2007: 39: 38-43. 0.785 0.303 0.580 0.568 0.936 p value CRAB的治疗-多黏菌素 静脉应用多黏菌素治疗总有效率为57%~80%. 肾功能损害的发生率约为0~37%. 雾化吸入有助于减少全身用药的副作用,并在 局部组织达到较高的药物浓度. 仍需进一步临床对照研究证实. Clin Microbiol Rev 2008: 21: 538-582. A case: PDRAB meningitis cefoperazone/sulbactam 35d Polymyxin E Jian Li, et al. AAC, 2006, 50:2946–2950 Passage of ATCC 19606 in CAMHB with or without colistin Hetero resistant to colistin passages clinic AB in broth containing colistin increased the proportion of the resistant subpopulations from 10E-8 to 10E-4 isolates MIC Before induction After induction* 6mg/L 8mg/L 10mg/L 6mg/L 8mg/L 10mg/L 16301 1.5mg/L 10E-6 10E-6 10E-6 10E-5 10E-5 10E-5 16302 1.5mg/L 10E-8 10E-8 10E-8 10E-4 10E-4 10E-4 10305 1.5mg/L 10E-7 10E-8 10E-8 10E-5 10E-5 10E-5 *8mg/L * 48小时，64mg/L * 48小时 4种主要消毒剂在有机干扰物存在的情况下杀菌活力显著下降 Triclosan resistance in clinical AB from China mainland MICs ranged between 0.015 and 16 mg/L and MIC90 was 0.5 mg/L, extremely lower than the actual in-use concentration of triclosan (2000-20000 mg/L). Triclosan MICs of 732 clinical AB Clinic used concentration 2000 … … … Factors leading to the emergence and transmission of MDRAB Lisa L, et al. CID 2008, 46:1254-1263. Contaminated surfaces increase cross-transmission X represents multi-drugs resistant pathogens culture positive sites 无处不在！ Highly refractory to both vigorouscleaning and to disinfectants! alcohol-based hand rubs may make matters worse rather than better!! Bernard Dixon. The Lancet Infectious Disease. 2008,8 alcohol or an alcohol-based hand rub provided the organism with an additional source of carbon 鲍曼不动杆菌为什么多重耐药？4 cluster of CHDLs in A. baumannii Anton Y. Peleg, et al. CMR. 2008, 21:538–582. Carbapenemases in Ab of China mainland Zhou H, et al. JCM. 2007, 45:4054-4057 MBLs in AB is less than CHDLs IMP-like: IMP-1、2、4、5、6、11 VIM-like: VIM-2 SIM-1 Usually class I integron encode, reported in Japan, Korea, Spain, England, Hongko