抗生素PPT课件（英文精品） Multi-drug resistant pathogens(67p)PPT.ppt

Multi-drug resistant pathogens;Disclosures;Agenda;Antibiotics;Why do we see more resistance?;My patient is really ill…;Getting It RightBloodstream Infections;Getting It RightVentilator-associated Pneumonia;Scope of the problem;NEW SUPERBUGS;;Bush classification of β-lactamases in GN bacteria;Substrate Profile;Substrate Profile;19 Months ESBL Klebsiella pneumoniae Outbreak New York Hospital Medical Center of Queens;Substrate Profile;Is Klebsiella bad?;Susceptibility Profile of KPC-Producing K. pneumoniae;Drugs with Most Reliable Activity Against ESBL-producing Enterobacteriaceae ;Carbapenem Resistance: Mechanisms;Carbapenemases;Carbapenemases in the U.S.;Klebsiella Pneumoniae Carbapenemase ;Susceptibility Profile of KPC-Producing K. pneumoniae;KPC Enzymes ;;KPC Outside of United States;;Carbapenemase – Producing Enteric GNR; U.K.;NDM1 Carbapenemase;Phenotypic Tests for Carbapenemase Activity;New transmission mechanisms;;;Modified Hodge Test;Which is more dangerous?;Resistance in gram-positive organisms ;Evolution of E. faecium resistance;Why is this different?;Populations with ca-MRSA;Disease Syndrome Skin/soft tissue (non-Trauma) Abscess Cellulitis Folliculitis Other/Unknown Wound (Traumatic) Urinary Tract Infection Sinusitis Bacteremia Pneumonia Osteomyelitis Septic arthritis Bursitis;MRSA skin infection: differential diagnosis;Range of the brown recluse;déjà vu;Phage type 80/81: PCN-R clone of SA Neonatal outbreaks in Australia in 50’s Became pandemic in adults/children in hospitals/communities Highly transmissible and virulent Carried leukocidin Robinson et al Phage type 80/81 carried PVL MLST 30 Current SWP clone of CA-MRSA descendant – acquired SCC IV;Okuma et al. J Clin Micro 2002 ;Distribution of Virulence and Resistance DeterminantsCA-MRSA (France, Switzerland, USA, Oceania);PVL associated with severe disease;;;Centers for Disease Control Campaign 12 steps to prevent antimicrobial resistance ;How To Prevent Resistance;Strategies for