泛耐药不动杆菌耐药现状及机制.pptVIP

泛耐药不动杆菌耐药现状及机制 Where does A. baumannii come from?A. baumannii, gen.sp. 3 and gen.sp. 13TU are the most frequent species in clinical specimens.The carrier rates for A. baumannii (including gen.sp. 13TU) ranged from 0.5 to 3% in healthy individuals, whereas for gen. sp. 3 the rates ranged from 2 to 6%.There is little evidence that A. baumannii is a typical soil.Therefore, A. baumannii has a low prevalence in the community and in the environment.Seifert, H. et al. JCM, 1997, 35: 2819–2825.Berlau, J. et al. Eur. J. Clin. Microbiol. Infect. Dis. 1999, 18: 179–183. NEJM 2009，Jan 29 全球关注的革兰阴性MDR 不动杆菌形态革兰氏染色阴性、无芽孢、两端钝圆、散在或个别成双排列、大小在(0．6～1．0) μm×(1．0～1．6) μ m 的杆状(球杆状)细菌陈翠珍等. 海洋水产讨论 2 0 0 5年8 月第26卷 第4期 MDR-Aba 对病死率、LOS、花费的影响AAC，2008，No3 CRAB感染相关危险因素的多变量分析CRAB,碳青霉烯类耐药鲍曼不动杆菌；OR, 相对危险度； CI,可信区间；Hello, S.L, et al. Scand J Infect Dis, 2010 Nature, 2005, 436: 758 92009年CARES：不同感染病原菌分布细菌名称菌株数BSI菌株数BSI分离率(％)HAP菌株数HAP分离率(％)IAI菌株数IAI分离率(％)大肠埃希1577.320631鲍曼不动杆菌343716.722628.8466.9肺炎克雷伯811514.67511.3铜绿假单胞菌271827.812616.1639.5金黄色葡萄球410613.5294.4凝固酶阴性葡萄630.4375.6屎肠球菌125514.820.37210.8阴沟肠杆菌85444.2283.6132粪肠球菌80302.900497.4嗜麦芽窄食单胞菌5190.9313.9111.7肺炎链球菌2550.5202.500黏质沙雷菌23161.550.620.3弗劳地枸橼酸杆菌2250.570.9101.5产气肠杆菌2280.88160.9鹑鸡肠球菌2110100111.7 不动杆菌感染的病死率ICHE, 2004, 25: 819-824; Richet HM, 2004, 44thICAAC, Washington DC.% 碳青霉烯类耐药不动杆菌在增加AAC, 2007，51 Acinetobacter isolates resistant to carbapenemsfrom the MYSTIC database, 2004 CMSS: 10家教学医院鲍曼不动杆菌的敏感性变迁S% Wang H, Chen M, et al. IJAA, 2010, 35: 227-2342003-2008中国大陆MDR的发生率 2009 CARES: CRAB在增加抗菌药物鲍曼不动杆菌(n=343)%耐药%敏感MIC50MIC90多粘菌素B1.298.80.51替加环素290.122米诺环素17.572216美罗培南60.136.73264亚胺培南60.136.43264头孢哌酮-舒巴坦32.5333264哌拉西林-三唑巴坦66.527.7256256阿米卡星68.230.9256256头孢他啶73.226.264256头孢吡肟68.826.264256环丙沙星76.123.66464左氧氟沙星68.223.6816 PUM：38 BY3： 17CY45TJ9 GZHY47GZZH： 30 XJ17 SY43