产碳青霉烯酶肺炎克雷伯菌的治疗ppt课件

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1、替加环素能否用于产碳青酶烯酶肺炎克雷伯菌（CRKP）的严重感染桂林市中医医院微生物中的“收藏家”虽然不是对抗生素天然耐药，但因为只产适量的青霉素酶染色体，被称为臭名昭著的“多耐药质粒的收藏家”A类碳青霉烯酶B类碳青霉烯酶D类碳青霉烯酶肺炎克雷伯菌耐药质粒编码KPCGESVIMIMPNDMOXA耐药进程氨基糖苷类β内酰胺类氟喹诺酮类碳青霉烯类泛耐药CRKPPolymyxins多粘霉素临床使用经验有限Fosfomycin磷霉素因广泛使用，耐药菌株已出现Tigecycline替加环素？？？？Clinicalstudies,antimicrobialtherapies,andoutc

2、omesforpatientsinfectedwithKPC-producingK.pneumoniaeReferenceCountry(yrofpublication)StudydesignNo.ofpatientswithindicatedinfectionTypeofβ-lactamase(no.ofisolates)Treatmentwithactivedrug(no.ofpatients)Outcome(no.ofsuccesses/no.offailures)182USA(2009)Caseseries3BSIsKPC-2(3)Tetracycline-amino

3、glycoside(1)1/0Colistin(3)1/2175Greece(2010)Case-controlstudy19BSIsKPC-2(19)Colistin(10)2/8162China(2008)Tigecycline-aminoglycoside(1)1/0Colistin-aminoglycoside(9)4/5274Greece(2011)Case-controlstudy53BSIsKPC-2(53)Carbapenem(1)0/1Colistin(7)3/4Tigecycline(5)3/2Aminoglycoside(2)2/0Colistin-am

4、inoglycoside(2)2/0Clinicalstudies,antimicrobialtherapies,andoutcomesforpatientsinfectedwithMβL-producingK.pneumoniaeReferenceCountry(yrofpublication)StudydesignNo.ofpatientswithindicatedtypeofinfectionTypeofMBL(no.ofisolates)Treatment(no.ofpatients)Outcome(no.ofsuccesses/no.offailures)86Gre

5、ece(2008)Tigecycline(1)1/056Spain(2008)Tigecycline-colistin(2)1/1269Taiwan(2001)Caseseries3BSIsIMP-8(3)Carbapenem(3)1/2143Taiwan(2004)Caseseries3(2pneumonias,1BSI)IMP-typeenzyme(3)Carbapenem(1)1/0240Greece(2008)Caseseries17(14BSIs,3pneumonias)VIM-1(17)Colistin(6)6/0Tigecycline(1)0/1175Greec

6、e(2010)Case-controlstudy18BSIsVIM-1(17)Colistin(10)6/4VIM-typeenzyme(1)Colistin-aminoglycoside(8)4/467Greece(2009)Prospectiveobservationalstudy67BSIsVIM-1(67)Carbapenem(14)11/3Carbapenem-colistin(8)8/0Colistin(15)11/4Noactivedrug(18)13/5RegimenA,combinationtherapywith≥2activedrugs,oneofwhic

7、hwasacarbapenem;regimenB,combinationtherapywith≥2activedrugs,notincludingacarbapenem;regimenC,monotherapywithanaminoglycoside;regimenD,monotherapywithacarbapenem;regimenE,monotherapywithtigecycline;regimenF,monotherapywithcolistin;regimenG,inappropriatet