不动杆菌感染及耐药.PPT

表1 14种抗菌药物对鲍曼不动杆菌的最低抑菌浓度(MIC)（μg/ml ）(2000年） 抗菌药物 耐药 中介 敏感 MIC50 MIC90 阿米卡星 94 4 2 256 256 氨苄西林 100 0 0 256 256 氨苄西林/舒巴坦 14 46 40 12 64 氨曲南 100 0 0 256 256 头孢吡肟 20 74 6 16 48 头孢哌铜　 100 0 0 256 256 头孢哌酮/舒巴坦 8 10 82 8 24 头孢噻肟 30 68 2 32 96 头孢他啶 26 66 8 16 64 环丙沙星 96 0 4 32 32 亚胺培南 100 0 0 32 32 美洛培南 100 0 0 32 32 哌拉西林/他唑巴坦 98 0 2 256 256 替卡西林/克拉维酸 100 0 0 256 256 10种抗菌药物耐药率比较 克隆分布 脉冲场凝胶电泳分析所有耐药鲍曼同源性，结果显示我院共有6个克隆株，其中A、B为我院主要克隆株。在临床各科室造成了广泛的流行。 克隆 A B C D E F 株数 50 35 6 2 1 1 科室 ICU 肝移植 等8个科室 肝移植 急监 肾内 等8个科室 散发于5个科室 呼吸 肾内 肝移植 克隆分布(株) A 50 B 35 C 6 D E F 浙一医院鲍曼不动杆菌PFGE分析结果（2004年） 克隆A 克隆B IMP 敏感 克隆D Heritier报道2003.8-2004.3年法国Toulouse一家大学医院烧伤病房暴发亚胺培南耐药鲍曼不动杆菌引起的院内感染，涉及六名患者。The age of the patients ranged from 20 to 91 years and all of them except patient F had been treated with imipenem previously, Infection with multidrug-resistant A. baumannii was considered to have contributed to the death of two out of the four patients who died (patients B and F). The unrelated environmental carbapenem-resistant A. baumannii isolate had a similar blaOXA-58-carrying plasmid, suggesting spread of this gene. （J Antimicrob Chemother. 2005 55(1):115-8）（OXA-58) * PFGE analysis after digestion of whole-cell DNAs with ApaI and SmaI restriction enzymes showed that six (isolates 2 to 7) out of the seven carbapenem-resistant isolates probably corresponded to a single strain. The environmental isolate (isolate 8) was of a different genotype, but it contained the same blaOXA-58-carrying plasmid (Figure 1). * the metallo-beta-lactamases encoded on transferable genes include IMP, VIM, SPM, and GIM and have been reported from 28 countries. * This trend correlates with the increasing use of carbapenem and ciprofloxacin but not with the use of extended-spectrum cephalosporins and aminoglycosides. * 不动杆菌感染及耐药 20℃-30℃环境下