耐药细菌感染和治疗.ppt

2g/day 3g/day 4.5g/day 4g/day MIC=8?g/ml时，美罗培南不同的给药方案TaM％ 3g/day 4g/day 6g/day 4.5g/day 6g/day MIC=16?g/ml时，美罗培南不同的给药方案TaM％ 对于MIC?4?g/ml的细菌，通常为肠杆菌科细菌，推荐：美罗培南0.5g q8h 或q6h, 一般不需要延长点滴时间。 对于MIC4 ?g/ml的细菌，通常为绿脓杆菌、不动杆菌，推荐：美罗培南单次剂量从1g起，1-2g, q8h 或q6h, 建议延长点滴时间。 美罗培南每日最大剂量可达6g，不良反应无明显增加。 在没有肾功能障碍时，不推荐q12的给药方法。 小 结 了解耐药菌分离率不断增高的趋势。 熟悉常见耐药菌、特征及有效药物。 掌握耐药菌感染治疗时，提高疗效应考虑的因素与措施。 * Thank you for your attention! * Once resistant strains of bacteria are present in a population, exposure to antimicrobial drugs favors their survival. Reducing antimicrobial selection pressure is one key to preventing antimicrobial resistance and preserving the utility of available drugs for as long as possible. KPC型β-内酰胺酶属于Ambler分类的A类、Bush分类的2f亚群,其特点是水解除头霉素类以外的几乎所有β-内酰胺类抗生素,包括青霉素类、头孢菌素类、单酰胺类和碳青霉烯类.其活性可被克拉维酸所抑制. * 2003年上海地区部分医院临床分离菌对各类抗菌药物的耐药性。 * * Introduction of every new class of antimicrobial drug is followed by emergence of resistance. By the 1950s, penicillin-resistant S. aureus were a major threat in hospitals and nurseries. By the 1970s, methicillin-resistant S. aureus had emerged and spread, a phenomenon that encouraged widespread use of vancomycin. In the 1990s, vancomycin-resistant enterococci emerged and rapidly spread; most of these organisms are resistant to other traditional first-line antimicrobial drugs. At the end of the century, the first S. aureus strains with reduced susceptibility to vancomycin were documented, prompting concerns that S. aureus fully resistant to vancomycin may be on the horizon. In June 2002 the first case of vancomycin-resistant S. aureus was detected. * 由于稳可信卓越的临床疗效和优秀的细菌学表现使之在抗耐药阳性菌药物中用于拥有了最广泛的适应症，涵盖了。。。。 利奈唑胺仅肺炎及皮肤软组织感染2个适应症，可透过血脑屏障， 在推荐剂量使用时，替考拉宁治疗导管相关感染及感染性心内膜炎的疗效不确切，并且他未被FDA批准在美国上市。 万古霉素、去甲万古霉素可口服用于由难辨梭状杆菌引起的与使用四环素、林可霉素等广谱抗生素有关的伪膜性结肠炎。用量为50万—200万单位。糖肽类药物均在正常情况下不易透过血脑屏障，但炎症时可达有效浓度；万古霉素和去甲万古霉素可通过胎盘屏障但不能进入房水。利奈唑胺口服生物利用度100%，口服与注射无需调整剂量。 * 不能清除 * * 万古霉素除了拥有广泛的适应症外，还被众多的权威指南推荐为治疗MRS感染的一线用药 最新出炉的《桑福德抗微生物治疗指南》（《热病》）10-11版，推荐万古霉素是MRS感