G菌感染的诊治简介.ppt

* * Treating MRSA Infections Key Point: Vancomycin remains the gold standard for MRSA treatment All treatments for MRSA have limitations Supplemental Information: Exposure to vancomycin may affect susceptibility to daptomycin Cell wall changes observed in glycopeptide-intermediate S aureus strains may interfere with daptomycin activity by decreasing the ability of daptomycin to access relevant binding regions on the bacterial cell membrane Reference: Sakoulas G, et al. Antimirob Agents Chemother. 2006;50:1581-1585. * The infectious organisms that are responsible for nosocomial pneumonia are generally different from pathogens associated with community-acquired respiratory infections. Nosocomial pneumonia infections can be caused by a wide variety of pathogens, though the most common are Staphylococcus aureus and the enteric gram-negative bacteria (such as Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa). However, it has been estimated that up to 50% of infections in mechanically ventilated patients are polymicrobial. This can make choosing targeted antimicrobial therapy difficult even after the pathogens are identified. Thus, broad spectrum antimicrobials and combination antimicrobial therapy are typically used to treat these infections empirically. * G+细菌的诊治简介 常见的G+球菌 ——葡萄球菌 凝固酶阳性葡萄球菌： 金黄色葡萄球菌 中间葡萄球菌 猪葡萄球菌 凝固酶阴性葡萄球菌 表皮葡萄球菌 溶血葡萄球菌：尿道感染、血流感染 腐生葡萄球菌：尿道感染（女，仅次于大肠杆菌） 瓦氏葡萄球菌： 里昂葡萄球菌： IE、骨髓炎、脑膜炎、腹膜炎、导管相关的血流感染 施氏葡萄球菌： 孔氏葡萄球菌：血流感染，肺部感染 头状葡萄球菌：主要是IE 2010年CHINET监测网各医院金葡菌MR菌株检出率 医院 金黄色葡萄球菌 医院　 金黄色葡萄球菌 MR株数/总株数 （%） MR株数/总株数 （%） 华山医院 265/409 64.8 上海儿科医院 / 42/365 11.5 瑞金医院 274/443 61.9 上海儿童医院 / 115/470 24.5 协和医院 243/560 43.4 重庆医大一附院 / 76/125 60.8 同济医院 361/578 62.5 甘肃省人民医院 / 85/142 59.9 浙医一附院 103/209 49.3 新疆医大一附院 / 207/349 59.3 广州一附院 66/101 65.3 安徽医大一附院 169/277 61.0 北京医院 191/246 77.6 昆明医大一附院 103/178 57.9 总计 2300/4452 51.7 常见的G+球菌——链球菌 β溶血性链球菌、非β溶血性链球菌、草绿色链球菌和罕见链球菌 β溶血性链球菌 非β溶血性链球菌 草绿色链球菌 化脓性链球菌 肺炎链球菌 变异链球菌群 无乳链球菌 马肠链球菌 唾液链球菌群 停乳链球菌