esbl检测筒的临床意义-.ppt

Meta-analysis of delay in effective therapy in ESBL-associated versus non-ESBL-associated Enterobacteriaceae bacteraemia. Forest plot summary of the unadjusted results of the 10 studies included in the meta-analysis. The relative risk (RR) and 95% confidence intervals (CIs) are shown for each study. The pooled RR, represented by the diamond at the bottom of the figure, is 5.56 (95% CI 2.94–10.51, P 0.001). There was significant heterogeneity among the study results (P 0.001). Meta-analysis of mortality in ESBL-producing versus non-ESBL-producing Enterobacteriaceae bacteraemia. Forest plot summary of the unadjusted results of the 16 studies included in the meta-analysis. The relative risk (RR) and 95% confidence intervals (CIs) are shown for each study. The pooled RR, represented by the diamond at the bottom of the figure, is 1.85 (95% CI 1.39–2.47, P 0.001). There was significant heterogeneity among the study results (P = 0.001). ESBL检测的临床意义 一、革兰阴性杆菌的主要耐药问题是产酶 1940s 2000s Penicillins Narrow-spectrum cephems Expanded-spectrum cephems Carbapenems AmpC-type β-lactamases Extended-spectrum β-lactamases (ESBLs) Carbapenemases Penicillinases Broad-spectrum β-lactamases S. aureus, H. influenzae, N. gonorrhoeae M. catarrhalis, V. cholerae, Enterobacteriaceae P. aeruginosa, Acinetobacter Enterobacteriaceae P. aeruginosa Acinetobacter b-lactamase-mediated Resistance: Evolution in the Clinical Setting Courtesy of Gian Maria Rossolini Delay in Effective Therapy in ESBL (+) vs ESBL (-) Enteric Bacteraemia Schwaber Carmeli J Antimicrob Chemother 2007;60:913 Mortality in ESBL (+) vs ESBL (-) Enterobacteriaceae Bacteraemia Schwaber Carmeli J Antimicrob Chemother 2007;60:913 二、 我国肠杆菌科细菌产ESBL 的现状 2011年15家医院11860株大肠埃希菌耐药率（%） 对亚胺培南和美罗培南的耐药率上升 对哌拉西林、氟喹诺酮类、庆大霉素和头孢噻肟的耐药率高（50%以上） 对碳青霉烯类、两种酶抑制剂复方、磷霉素和阿米卡星的耐药率低 2011年15家医院6981株克雷伯菌属耐药率（%） 对亚胺培南和美罗培南的耐药率上升 Prevalence of ESBLs CHINET surveillance, China, 2005-2009 产ESBLs肠杆菌的检出率居高不下 检出率(%) 2005年，我国大肠埃希菌和肺炎克雷伯菌产ESBLs菌株的检出率分别为38.9%和39.1%