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1、ChineseJournalofNewDrugs2011,20(3)综述产NDM1泛耐药肠杆菌科细菌感染抗菌治疗肖永红(浙江大学医学院附属第一医院传染病诊治国家重点实验室,杭州310003)[摘要]产NDM1泛耐药肠杆菌科细菌(主要为大肠埃希菌、肺炎克雷伯菌)对头孢菌素、碳青霉烯类等广泛耐药,主要引起长期住院、应用广谱抗菌药物、免疫抑制、器官移植以及接受侵袭性操作等住院患者感染;细菌仅对替加环素、多黏菌素等少量抗菌药物敏感,临床缺乏有关感染治疗的研究结果;参考其他产碳青霉烯类肠杆菌科
2、感染抗菌治疗研究报道,建议根据药物敏感性测定结果选择抗菌药物,轻症感染可单用阿米卡星、磷霉素、喹诺酮类等,重症感染一般需要联合用药,包括替加环素、多黏菌素、碳青霉烯类、阿米卡星等;加强医院感染控制与合理使用抗菌药物是防止产NDM1泛耐药肠杆菌科细菌扩散的重要手段。[关键词]产NDM1肠杆菌科细菌;替加环素;多黏菌素;医院感染;抗菌治疗[中图分类号]R978.1[文献标志码]A[文章编号]1003-3734(2011)03-0219-06Antibacterialtherapyfort
3、heinfectionsofNDM1producingEnterobacteriaceaeXIAOYonghong(StateKeyLaboratoryofDiagnosisandTreatmentforInfectiousDiseases,TheFirstAffiliatedHospital,SchoolofMedicine,ZhejiangUniversity,Hangzhou310003,China)[Abstract]Inisolatedbacteriathatarefullyres
4、istanttoantibiotics(pandrugresistant),onetypeisNDM1producingEnterobacteriaceae(mainlyincludingEscherichiacoliandKlebsiellapneumoniae).Thismayleadtothenosocomialinfectionsinhospitalizedpatientswithlongtermstay,broadspectrumantibioticapplication,im
5、munodeficiency,organtransplantationorinvasiveoperation,etc.Onlyisthegermsusceptibletofewantibacterialagentssuchastigecyclineandpolymyxin,andthereisnocomprehensiveinvestigationabouttheantibacterialchemotherapyforitsinfections.Theantibacterialtreatment
6、fortheseinfectionsshouldrefertotheinvitroantibacterialsusceptibletestresultsandclinicalstudyreportsforothercarbapenamaseproducingEnterobacteriaceaeinfections.Inprinciple,amikacin,fosfomycinorfluoroquinolonescouldbeemployedsinglyastheagentsformildinfe
7、ction,antimicrobialcombinationincludingtigecycline,polymyxin,carbapenams,amikaxinshouldbeconsiderationsforthesevereinfections.ThemajormeasuresforthecontrolofNDM1producingEnterobacteriaceaespreadarerationaluseofantibioticsandenforcementofnosocomialinf
8、ectionprevention.[Keywords]NDM1producingEnterobacteriaceae;tigecycline;polymyxin;hospitalinfections;antibacterialtherapy2010年8月LancetInfectiousDiseases报道了(NewDelhimetallolactamase1,NDM1)肠杆菌科有关南亚和英国产型新德里金属内酰胺酶细菌(以下称:产NDM1细菌)流行情况,
