2011细菌耐药与抗菌药物合理应用_武汉课件.ppt

细菌耐药又分为固有耐药和获得性耐药，前者如铜绿假单胞菌对氨苄西林、厌氧菌对氨基糖苷类 后者如肠球菌对万古霉素耐药vanA型和vanB型耐药、肺炎链球菌对大环内酯类的耐药(ermB) * * 获“朝鲜民主主义共和国英雄”称号和一级国族勋章者： 彭德怀 杨根思 黄继光 孙占元 杨连弟 邱少云 伍先华 许家明 杨修道 杨春增 杨育才 李家发 特级英雄： 杨根思 黄继光 一级英雄： 卜个德 于泮宫 于喜田 毛张苗 王兆才 王学风 王海 王德明 孔庆三 刘玉堤 刘庆亮 刘维汉 伍先华 孙占元 孙生禄 孙振禄 许家明 沈如根 吴志洲 余新发 李凤林 李延年 李家发 陈德忠 邱少云 杨连弟 杨宝山 杨育才 杨春增 员宝山 周厚刚 张永富 张积德 吸修道 赵宝桐 倪祥明 柴云振 秦建彬 徐长富 高成山 高景灏 郭忠田 郭思志 曹玉海 曹玉功 黄家富 崔建国 雷宝森 谭炳云 魏长德 一级模范： 王兴记 罗盛教 张益仁 孙风钜  * In 1945, a few years after Penicillin was introduced to the world, Fleming created a strain of Staphylococcus aureus that was resistant to penicillin. This was accomplished by exposing s. aureus to sub-optimal doses of Penicillin. Fleming warned the world about antibiotic resistance during an interview with the New York Times. Between 1945 and 1955, Penicillin was available to the public over the counter, without a prescription. During those ten years the public did in vivo what Fleming did in vitro: People stopped taking PCN as soon as they began to feel better, they took PCN for viral infections, some reports even say PCN was used to treat male pattern baldness… * * * * * 2006年9所医院分离肠球菌占阳性菌比例24.3%. 2004-2005年度卫生部全国细菌耐药监测结果,肠球菌占26.9%,2006-2007年占24.3% 2005年全国15家教学医院院内活动病原菌耐药分析显示(SEANIA),肠球菌占阳性菌比例为36.9%. * * * * * * 要点：对大环内酯耐药的肺炎链球菌在世界各地都很严重，亚洲地区已超过70% 见幻灯 * * * * * * * * 4 * * Is this only in Japan? * and in the world. * * In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care. A mean of 56% of body sites and 17% of environmental sites were VRE positive. After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE. After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated. The inanimate environment plays a role in facilitating transmission of organisms. * This iceberg graphically represents colonization versus infection. Those patients that are infected with an organi