多重耐药鲍曼不动杆菌流行与诊治.ppt

《多重耐药菌医院感染防控研究及应用》 忐忑，不能胜任 * * 27 patients received iv monotherapy with carbapenems (21 cases), ampicillin/sulbactam (4 cases), ciprofloxacin (1 case) and amikacin (1 case). In 4 cases, a combined parenteral therapy was used with imipenem (three cases) or ceftazidime (one patient) and aminoglycosides.Nineteen patients received a combined iv and intrathecal therapy with colistin (eight cases), iv carbapenems and iv and intrathecal (four cases) or only intrathecal (five cases) aminoglycosides, iv ceftazidime and intrathecal tobramycin (one case) and iv ampicillin/sulbactam and iv and intrathecal amikacin (one case). The mean duration of treatment was 17.4 + 8.3 days (range 3–44). In 36 cases, treatment was associated with the removal of the intraventricular catheter. 中枢神经系统感染，其中最主要的致病菌为金葡菌和凝固酶阴性葡萄球菌，分别占到为50.9％和16.2％ * Sputum gram stain shoing epithelial cells and Gpc in chains * * * The carbapenem-hydrolyzing class D OXA-type β-lactamases in A. baumannii are classified into three acquired genes (OXA-23, 24/40 and 58) and the naturally occurring OXA-51. * We confirmed blaOXA-23 with ISAbaI upstream as a promoter to enhance the expression of OXA-23 was the most popular carbapenemase genotypes in China. * * * 在这张图上，横坐标是舒巴坦的浓度，纵坐标是被抑制的不动杆菌累计比例。 我们可以看到，随着舒巴坦浓度的增加，被抑制的不动杆菌累计比例也逐渐升高，敏感性可达60-100%。 这说明，舒巴坦具有内源性抗菌活性，可以直接抑制不动杆菌。 * * * * 0.65–3.50 μg/mL 90 min after a 1 g sulbactam dose 氨苄西林/舒巴坦：给药剂量为3.0g q6h * 这是体外诱导实验的结果，不一定真正反应临床多黏菌素耐药株的耐药机制 * However, the hetero-resistance of A. baumannii to colistin should be paid more attention, since several studies reported the evolution of resistance in the process of therapy with colistin. 局部用药： 副作用小, 局部浓度高，the last-resort options * EUCAST和FDA标准有差异；阳性菌无耐药折点 * 泰阁具有非常标准的线性药代动力学特征，Cmax及AUC均随给药剂量线性增加。 In an ascending single-dose study by Muralidharan et al, the tigecycline Cmax and AUC increased proportionally to the dose in the range of 12.5 to 300 mg. In fact, a linear relationship was seen between Cmax and dose (r2 = 0.99) and