产碳青霉烯酶肺炎克雷伯菌的治疗.pptVIP

替加环素能否用于产碳青酶烯酶肺炎克雷伯菌（CRKP）的严重感染 桂林市中医医院 微生物中的“收藏家” 虽然不是对抗生素天然耐药，但因为只产适量的青霉素酶染色体，被称为臭名昭著的“多耐药质粒的收藏家” 耐药进程 泛耐药CRKP Clinical studies, antimicrobial therapies, and outcomes for patients infected with KPC-producing K. pneumoniae Reference Country (yr of publication) Study design No. of patients with indicated infection Type of β-lactamase (no. of isolates) Treatment with active drug (no. of patients) Outcome (no. of successes/no. of failures) 182 USA (2009) Case series 3 BSIs KPC-2 (3) Tetracycline-aminoglycoside (1) 1/0 Colistin (3) 1/2 175 Greece (2010) Case-control study 19 BSIs KPC-2 (19) Colistin (10) 2/8 162 China (2008) Tigecycline-aminoglycoside (1) 1/0 Colistin-aminoglycoside (9) 4/5 274 Greece (2011) Case-control study 53 BSIs KPC-2 (53) Carbapenem (1) 0/1 Colistin (7) 3/4 Tigecycline (5) 3/2 Aminoglycoside (2) 2/0 Colistin-aminoglycoside (2) 2/0 Clinical studies, antimicrobial therapies, and outcomes for patients infected with MβL-producing K. pneumoniae Reference Country (yr of publication) Study design No. of patients with indicated type of infection Type of MBL (no. of isolates) Treatment (no. of patients) Outcome (no. of successes/no. of failures) 86 Greece (2008) Tigecycline (1) 1/0 56 Spain (2008) Tigecycline-colistin (2) 1/1 269 Taiwan (2001) Case series 3 BSIs IMP-8 (3) Carbapenem (3) 1/2 143 Taiwan (2004) Case series 3 (2 pneumonias, 1 BSI) IMP-type enzyme (3) Carbapenem (1) 1/0 240 Greece (2008) Case series 17 (14 BSIs, 3 pneumonias) VIM-1 (17) Colistin (6) 6/0 Tigecycline (1) 0/1 175 Greece (2010) Case-control study 18 BSIs VIM-1 (17) Colistin (10) 6/4 VIM-type enzyme (1) Colistin-aminoglycoside (8) 4/4 67 Greece (2009) Prospective observational study 67 BSIs VIM-1 (67) Carbapenem (14) 11/3 Carbapenem-colistin (8) 8/0 Colistin (15) 11/4 No active drug (18) 13/5 Regimen A, combination therapy with ≥2 active drugs, one of which was a carbapenem; regimen B, combination therapy with ≥2 active drugs, not including a carbapenem; regimen C, monotherapy