腹腔感染细菌学特点和抗生素治疗策略分析.pptVIP

复杂腹腔感染：感染自空腔脏器扩展至腹膜腔内，合并脓肿形成或腹膜炎的一类疾病 除感染源控制措施（Source control）外，还需使用抗菌药物 但cIAI不用于评价腹腔感染严重度，即复杂腹腔感染并不意味着重症感染，或耐药菌所致的院内感染 刚才提到的这些常见的复杂腹腔感染性疾病多为社区获得性腹腔感染，它们的病原学特点如下 在上消化道： 以肠道杆菌科细菌为主（大肠埃希菌，克雷伯菌属，肠杆菌属）；厌氧菌的检出也逐渐增多 在下消化道： 除肠道杆菌科细菌外，厌氧菌明显增多，主要是拟杆菌，尤其是脆弱拟杆菌 * CR = 碳青酶烯耐药 Int J Antimicrob Agents.?2012 Jun;40 Suppl:S4-10. doi: 10.1016/S0924-8579(12)70003-1. Impact of revised CLSI breakpoints for susceptibility to third-generation cephalosporins and carbapenems among Enterobacteriaceae isolates in the Asia-Pacific region: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2002-2010. Huang CC1,?Chen YS,?Toh HS,?Lee YL,?Liu YM,?Ho CM,?Lu PL,?Liu CE,?Chen YH,?Wang JH,?Tang HJ,?Yu KW,?Liu YC,?Chuang YC,?Xu Y,?Ni Y,?Ko WC,?Hsueh PR. Author information Abstract This study examined the rates of susceptibility to third-generation cephalosporins and carbapenems among Enterobacteriaceae isolates that had been obtained from patients with intraabdominal infections in the Asia-Pacific region as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). Susceptibility profiles obtained using 2009 Clinical and Laboratory Standards Institute (CLSI) breakpoints were compared with those obtained using the 2011 CLSI breakpoints. From 2002 to 2010, Escherichia coli and Klebsiella pneumoniae together accounted for more than 60% of the 13714 Enterobacteriaceae isolates analyzed during the study period. Extended-spectrum β-lactamase (ESBL) producers comprised 28.2% of E. coli isolates and 22.1% of K. pneumoniae isolates in the Asia-Pacific region, with China (55.6% and 33.7%, respectively) and Thailand (43.1% and 40.7%, respectively) having the highest proportions of ESBL producers. Based on the 2011 CLSI criteria, 77.2% of the Enterobacteriaceae isolates, 40.4% of ESBL-producing E. coli, and 25.2% of ESBL-producing K. pneumoniae isolates were susceptible to ceftazidime. Carbapenems showed in vitro activity against 90% of Enterobacteriaceae isolates in a