多重耐药细菌的抗生素选择（英文ppt）extendingour options for multidrug resistant

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1、ExtendingOurOptionsforMulti-drugResistantPathogensCarolMiller,PharmD,BCPSKatherinePickerill,PharmDFebruary9,2011WhyisResistanceaConcern?ResistantorganismsarebecomingcommonplaceBacterialresistanceoftenresultsintreatmentfailureandincreasedmortalityandcostTheproblemisnolongercon

2、finedtothehospitalsettingBacterialresistancewillcontinuetoworsenifnotaddressedTherearenoantibioticsontheimmediatehorizonwithactivityagainstthesemulti-drugresistantpathogensObjectivesDescribethemagnitudeoftheproblemofantibioticresistanceReviewthemechanismsofresistanceIdentifywa

3、ystocombatantimicrobialresistanceReviewprinciplesofpharmacokineticsandpharmacodynamicsIntroduceantimicrobialstewardshipMechanismsofResistanceEnzymaticinhibitionDecreaseduptakeIncreasedexportAlteredtargetMetabolicbypassTransferofResistanceTroublesomeBacteriaAbilityto“escape”the

4、effectsofcurrentantimicrobialtherapyEnterococcusfaeciumStaphylococcusaureusKlebsiellapneumoniaeAcinetobacterbaumanniiPseudomonasaeruginosaEnterobacterspeciesESKAPERedefiningESKAPEasESCAPEEnterococcusfaeciumStaphylococcusaureusClostridiumdifficileAcinetobacterbaumanniiPseudomon

5、asaeruginosaEnterobacteriaceaeESCAPEAcknowledgesthegrowingvirulenceofC.difficileCapturesKlebsiella,Enterobacter,andotherresistantspeciesincludingE.coliandProteussp.ResistanceinGramPositiveBacteriaVRENon-existentasrecentlyas1989NNISreport(2004)–30%ofallenterococcalisolatesarere

6、sistantMediatedbyvanAandvanBgenesresultinginalterationoftargetsiteClonalspreadviapoorinfectioncontrolVariousantibioticsmayleadtoVREcolonizationAnti-enterococcalactivityBiliaryexcretionAnaerobicactivityResistanceinGramPositiveBacteriaMRSANNIS(2004)–60%ofS.aureusaremethicillinre

7、sistantNosocomialmecAgeneencodeslowaffinityforPBPresultinginresistancetoallbeta-lactamsUsuallymulti-drugresistantCommunity-acquiredMorevirulent–Panton-ValentineleukocidinSkinandsofttissueinfectionsinchildrenandyoungadultsUsuallysusceptibletononbeta-lactamdrugsVISACellwallthick

8、eningVRSAHorizontaltransferofavanAgenefromVREResistanceinGram