第十抗菌药物的合理应用.pptVIP

选择指数（selection index,SI）:MPC/MIC之比。指药物诱导耐药突变株产生的能力。越大能力越强。 选择性压力（ selection pressure）即在抗菌药物浓度-时间曲线上,低于MIC的曲线下面积。半衰期长而抗菌活性低的抗菌药物,较活性高而半衰期短的药物的选择性压力要大。 2021/3/17 * 三、MPC的测定方法与研究概况 方法:细菌的耐药突变频率为10-7-10-8,在接种菌量为1010cfu（Colony-Forming Units ）/ml的琼脂平板上测定,以MPC为上界,MIC为下界的这一浓度范围称为MSW。 MIC筛选常为103cfu/ml。 When considering the etiologic agent of a surgical site infection, the organisms encountered change according to the depth of the tissue involved. Superficial infections and cellulitis are usually caused by streptococci and staphylococci. As the infection spreads deeper, gram-negative rods and anaerobes become more common. [Nichols, p.S87] Thus, in choosing the appropriate prophylactic agent, it is important to know which organisms will be encountered. Reference Nichols RL, Florman S. Clinical presentations of soft-tissue infections and surgical site infections. Clin Infect Dis. 2001;33(suppl 2):S84-S93. Approved: 2004 EPCP Perioperative Antibiotic Prophylaxis Surgery Presentation, Slide 37 Nichols, p.S87 Bacteria have evolved numerous mechanisms to evade antimicrobial drugs. Chromosomal mutations are an important source of resistance to some antimicrobials. Acquisition of resistance genes or gene clusters, via conjugation, transposition, or transformation, accounts for most antimicrobial resistance among bacterial pathogens. These mechanisms also enhance the possibility of multi-drug resistance. 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 No.4 ?-内酰胺酶类抗生素通过与细菌细胞膜上的靶位分子-青霉素结合蛋白相结合而杀灭细菌。若细菌产生?-内酰胺酶，抗生素在与靶位分子结合前先与酶相遇，被其水解从而不能与细胞靶位分子结合发挥抗菌作用。 要点：防突变浓度（MPC）能预测药物是否会诱导耐药 MPC是 国际最新的预测抗菌活性以及防止耐药的重要指标。 要点：如果药物浓度仅高于MIC，耐药突变株可能会选择性扩增并播散流行 细菌感染时，假定在10亿野生菌株中会存在2个耐药突变株，这时候使用仅仅高于致病菌MIC的药物，可以将敏感细菌杀死，但是耐药菌株不能被杀死（10亿野生菌株中有200个耐药突变株），根据患者免疫