课件：不动杆菌流行及治疗(林晓).ppt

谢谢大家 * 该研究分析了美国National Nosocomial Infections Surveillance (NNIS) system1986-2003年的ICU院内革兰阴性感染变化情况.鲍曼不动杆菌在医院获得性肺炎中的比例由1986年的4%上升至2003年的7%,具有显著的统计学差异,同时伴随对常用抗菌药物的耐药率逐年提高. * * OAX23在中国为盛行株 * * * In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care. A mean of 56% of body sites and 17% of environmental sites were VRE positive. After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE. After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated. The inanimate environment plays a role in facilitating transmission of organisms. * * 在这张图上，横坐标是舒巴坦的浓度，纵坐标是被抑制的不动杆菌累计比例。 我们可以看到，随着舒巴坦浓度的增加，被抑制的不动杆菌累计比例也逐渐升高，敏感性可达60-100%。 这说明，舒巴坦具有内源性抗菌活性，可以直接抑制不动杆菌。 * 未发现对消毒剂的抗性，也未发现抗生素耐药与消毒剂抗性之间的联系 对目前使用消毒剂耐药可能并不是目前鲍曼不动感觉流行播散的最重要原因 消毒措施偏差所导致的浓度和暴露时间减少可能导致院内交叉感染的发生 Contaminated surfaces increase cross-transmission X represents multi-drugs resistant pathogens culture positive sites 无处不在！ Acinetobacter Transmission in the Hospital Setting Direct or indirect contact Contaminated hands of healthcare workers Airborne transmission via aerosol production (e.g., hydrotherapy) may occur Environmental Contamination with Acinetobacter Bed rails Bedside tables Ventilators Infusion pumps Mattresses Pillows Air humidifers Patient monitors X-ray view boxes Curtain rails Curtains Equipment carts Sinks Ventilator circuits Floor mops 抗生素的应用 ？！ Susceptiblity of A. baumannii: 1994-2004 (1874 isolates) Susceptibiligy(%) Year Antimicrobial Resistance among Acinetobacter sp., From ICUs 1986-2003 2008年12家医院3508株不动杆菌属(鲍曼不动86.2%)细菌的耐药率（%） ?对头孢哌酮/舒巴坦耐药率较低。对其他药耐药率均较高。 ?两种碳青霉烯类耐药率均48%，高于2007年。 Major infections due to Acinetobacter Ventilator-associated pneumonia Urinary tract Bloodstream infection infection Secondary meningitis Skin/wound infections Endocarditis peritonitis Endophthalmitis How to treat infections caused by MDR A. ba