革兰阴性菌感染治疗需关注esbls广州.pptVIP

革兰阴性菌感染治疗需关注ESBLs? ;你认为该怎么办？;超广谱?-内酰胺酶（extended spectrum ?-lactamases，ESBLs）;July 2004 : Media ‘discovers’ CTX-M;如何测出 ESBLs;ESBL流行病学的改变;2010 AAC;2011年CHINET耐药监测革兰阴性菌菌种分布;Common ESBL producers:;肠杆菌科细菌 临床关注的主要?-内酰胺酶;Are ESBL producers associated with higher mortality?;产ESBLs菌株血行感染死亡率显著增加（Meta分析）;;Worldwide prevalence of ESBL producers;社区获得性产ESBLs菌株感染的定义;;2099株革兰阴性菌分布;主要肠杆菌科细菌耐药性; Species Distribution of GNB Causing IAIs 2,292 Isolates, China, SMART, 2002-2007; Rates of ESBL-producing E. coli and K. pneumoniae from Community-onset (Data from SMART 48 h in China);Emergence of High Levels of Extended-Spectrum--Lactamase-Producing Gram-Negative Bacilli in the Asia-Pacific Region（SMART 2007）;Asia-Pacific Region（SMART 2007）;ESBLs – an emerging problemGlasswell et al, Healthcare-associated Infection and Antimicrobial Resistance Dept Antimicrobial Resistance Monitoring and Reference Laboratory, Health Protection Agency, Colindale, London;Community acquisition of ESBL-producing Escherichia coli: a growing concern MJA ? Volume 190 Number 1 ? 5 January 2009;医院获得（HA）与社区获得（CA）产ESBLs大肠埃希菌的比较;Healthcare associated community-onset ESBL-producing E. coli infections;;医院获得（HA）与社区获得（CA）产ESBLs菌株感染－特点比较;Prevalence of ESBLs CHINET surveillance, China, 2005-2009;中国ESBL的发生率 ;产ESBLs菌株血行感染：病死率增加的危险因素之一——广谱头孢菌素的治疗;产ESBLs菌株感染：头孢菌素的经验性治疗疗效判断 ;产ESBLs菌株血行感染：头孢菌素的经验性治疗疗效判断——与MIC的相关性;产ESBLs菌株感染：头孢菌素的经验性治疗疗效判断——与MIC的相关性;肠杆菌科对头孢类,氨曲南  新折点 (MIC μg/ml)*;评估了但不需要修改折点的药;;;产ESBLs菌株感染：不同抗菌药物经验性治疗疗效比较;产ESBLs菌株感染：头孢菌素的经验性治疗疗效判断——与MIC的相关性;产ESBLs菌株感染－不同抗菌药物经验性治疗疗效比较;抗菌药物对产ESBLs菌抗菌活性;产ESBLs菌株感染：不同抗菌药物经验性治疗疗效比较;产ESBLs菌株血行感???：不同抗菌药物经验性治疗疗效比较;产ESBLs菌株血行感染：不同抗菌药物经验性治疗疗效比较;产ESBLs菌株血行感染：不同抗菌药物经验性治疗疗效比较;Clinical Infectious Diseases 2010; 50:40–8;;产ESBLs菌株感染：抗菌药物的选择;产ESBLs菌株感染的危险因素;产ESBLs菌株感染的合并症;产ESBLs菌株感染前的抗菌药物应用;Clin Infect Dis. 2010 Jan 1;50(1):40-8.;西班牙13家三甲医院2004.10~2006.16000，000病人;影响预后的因素;;适当的经验性治疗appropriate empiric therapy;社区获得性产ESBLs大肠埃希菌感染－危险因素;;社区获得性产ESBLs大肠埃希菌感染－危险因素;社区获得性产ES