多重耐药菌感染的防控与治疗.ppt

* * * * 06年全球著名的医学杂志《柳叶刀》上发表了一篇文章，疾呼耐药葡萄球菌在全球范围内快速蔓延，已经成为全球共同面对的公共卫生问题。 这张图反映了世界各地所报道的MRSA的发生率：不同的颜色显示不同的发生率，亚洲的香港、新加坡、日本等都已超过了50%。 2008年中国的CHINET报道，中国的MRSA、MRCNS的平均发生率分别为58%和77.2% * Oxazolidinedione Linezolid (Zyvox?) Streptogramins Quinupristin/dalfopristin (Synercid?) Pristinamycin (not yet A/V) Second generation glycopeptides Dalbavancin (Zeven?) Oritavancin (not yet A/V) Cyclic lipoglycopeptide Daptomycin (Cubicin?) Ketolide Telithromycin (Ketek?) Glycylcycline Tigecycline (Tygacil?) Polymixins Colistin (Colomycin?) * Acinetobacter Acinetobacter species are aerobic gram-negative bacteria that are widely distributed in soil and water and can occasionally be cultured from skin, mucous membranes, secretions, and the hospital environment.Acinetobacter baumannii is the species most commonly isolated. A baumannii has been isolated from blood, sputum, skin, pleural fluid, and urine, usually in device-associated infections. Acinetobacter encountered in nosocomial pneumonia often originates in the water of room humidifiers or vaporizers. In patients with acinetobacter bacteremia, intravenous catheters are almost always the source of infection. In patients with burns or with immune deficiencies, acinetobacter acts as an opportunistic pathogen and can produce sepsis. Acinetobacter strains are often resistant to antimicrobial agents, and therapy of infection can be difficult. Susceptibility testing should be done to help select the best antimicrobial drugs for therapy. Acinetobacter strains respond most commonly to gentamicin, amikacin, or tobramycin and to newer penicillins or cephalosporins. * 严格执行抗菌药物分级管理制度 医疗机构要按照《抗菌药物临床应用指导原则》中“非限制使用”、“限制使用”和“特殊使用”的分级管理原则，建立健全抗菌药物分级管理制度，明确各级医师使用抗菌药物的处方权限。 根据抗菌药物临床应用监测情况，以下药物作为“特殊使用”类别管理。医疗机构可根据本机构具体情况增加“特殊使用”类别抗菌药物品种。 “特殊使用”类别抗菌药物 第四代头孢菌素：头孢吡肟、头孢匹罗、头孢噻利等； 碳青霉烯类抗菌药物：亚胺培南/西司他丁、美罗培南、帕尼培南/倍他米隆、比阿培南等； 多肽类与其他抗菌药物：万古霉素、去甲万古霉素、 替考拉宁、利奈唑胺等； 抗真菌药物：卡泊芬净，米卡芬净，伊曲康唑（口服液、注射剂），伏立康唑（口服剂、注射剂），两性霉素B含脂制剂等。 抗菌药物分级管理原则 根据患