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1、多重耐药鲍曼不动杆菌感染的治疗OUTLINE不动杆菌在临床分离菌中的比例不动杆菌的耐药性问题不动杆菌感染的抗菌治疗ConfusionofMDR,XDR,PDRdefinitionsThedefinitionsofMDR,XDR,PDRaresomewhatconfusing:ThereisnoorganizationorassociationresponsibleforgivingthedefinitionsDifferentdefinitionsofPDRaremadebydifferentpro
2、fessionalpersonsXDRisusedforbothMycobacteriumtuberculosisandcommonbacteriaTherapidincreasingofbacterialresistancechangesthedefinitionsuchasMDRControversyofdefinitionsbetweenPatersonandFalagasinCIDFalagasM,CID2008;46:1121PatersonD,CID2008;46:1122Univ.of
3、QueenslandCentreforClinicalResearch,AustraliaAlfaInstituteofBiomedicalSciences,GreeceTuftsUniv.MA,USASemanticdifferenceof“X”inXDRExtensiveDrugResistance(Extensivelydrug-resistant)(XDR)forM.tuberculosis1andcommongram-negativebacilli2ExtremeDrugResistanc
4、e(XDR)forcommonGNB3MMWRMorbMortalWklyRep2006;55:301FalagasM,CID2008;46:1121PatersonDL,CID2007;45:1179DefinitionsofMDR,XDR,PDRbyFalagasDefinitionsofPDR,XDRandMDR:多重耐药MDR(multidrugresistance):resistance≥3classesofantimicrobials极度耐药XDR(extensivedrugresist
5、ance):resistancetoallbut1or2泛耐药PDR(pandrugresistance):resistancetoALLWhyPDRdefinedasresistanttoallantimicrobials?Theprefix“pan-”means“all”or“whole”Semantically,“extreme”(firstusedinthefieldofoncology/hematology)cannotbemoreinclusivethan“pan-”FalagasM,C
6、ID2008;46:1121DefinitionofXDR(ExtremeDrugresistance)forGNBbyPatersonLackingsusceptibilityto:β-lactams:Cefepime,Ceftazidime,Imipenem,Meropenem,Piperacillin/tazobactamQuinolones:Ciprofloxacin,Levofloxacinplusto:Ticarcillin-clavulanate,Ampicillin-sulbacta
7、mAminoglycosidesincludingamikacinTigecyclinePolymyxins(colistinandpolymyxinB)PatersonDL,CID2007;45:1179EqualtothedefinitionofPDRbyFalagas常见糖非发酵菌Non-fermenters假单胞菌属铜绿假单胞菌Pseudomonasaeruginosa不动杆菌属鲍曼不动杆菌Acinetobacterbaumannii窄食单胞菌属嗜麦芽窄食单胞菌Stenotrophomona
8、smaltophilia产碱杆菌属粪产碱杆菌Alcaligenesfaecalis伯克霍尔德菌属洋葱伯克霍尔德菌Burkholderiacepacia黄杆菌属(金黄杆菌属)脑膜败血黄杆菌Flavobacteriummeningosepticum（脑膜败血金黄杆菌Chryseobacteriummeningosepticum）上海地区糖非发酵菌 在革兰阴性杆菌比例的上升趋势(WangF,etal.IntJAntimicrobAgents2003;22:444)Year革
