革兰阴性菌耐药及治疗.pptVIP

* * * * 由于AmpC酶本身具有的特点，临床上可供选择的抗生素有如下几种：美罗培南等碳青霉烯类，对AmpC酶稳定，最有效。 此外，氟喹喏酮及氨基糖苷类也是治疗的选择药物，另一方面，由于易产AmpC酶的肠杆菌属细菌往往同时携带有氟喹诺酮、氨基糖苷类的耐药基因或ESBL，因此参考药敏报告十分必要，一般不推荐使用。 特别需要强调的是，临床上应禁止使用3代头孢菌素及酶抑制剂复合制剂及氟氧头孢治疗持续高产AmpC酶的细菌感染。 * * * * * * * Slide * If ESBL-producing bacteria are allowed to flourish and cause clinical infection, the use of even more broad-spectrum antibiotics will be necessary, including the use of carbapenem agents. Although this clearly can lead to cure of a given infection caused by an ESBL-producing bacteria, several published reports link increased use of carbapenem antibiotics to outbreaks of multidrug-resistant P. aeruginosa or A. baumannii. In contrast, penicillin-based therapy combined with a reduction in third-generation cephalosporin use appears to limit both colonization and infection with ESBL-producing Enterobacteriaceae. * * * 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。 * 那么，把TAM作为参数的药剂，增加TAM ％就可以获得更高的细菌学疗效，不管怎样增加TAM ％是可以吧。 例如，同样的1日量，比较按1日2次给药和3次给药的TAM，正如所看到，增加给药次数，TAM ％也可以增加。 像这样根据PK/PD 设计给药方法，就可以期待获得更高的细菌学疗效。 Key Points Static and cidal activity of beta-lactam antibiotics depends on the time that free drug levels exceed the MIC of the pathogen Carbapenems have the shortest % time MIC requirement * 治疗细菌感染的抗菌药物选择 最可能的病原菌什么？ 培养阴性时？ 多种菌种被培养出来时？ 对阳性结果的正确判定？ 耐药性的评估:是否为耐药菌？ MDR、XDR、PDR机会有多少？ 病情的评估：是否重症感染？ 各种评估指标 CRP、PCT等 合理给药方案：PK/PD参数优化 WHO has called for a global response Antibiotics Resistance is an urgent global problem The use of gloves (CDC) MMWR, 2002, 51:RR-16 Fundamentals: “Wearing gloves does not replace the need for handwashing”gloves after caring for a patient. Do not wear the same pair of gloves for the care of more then one patient.” “Failure to change gloves between patient is an infection control hazard”. Look at the gloves Photo from SCMP Thank you for attention! * * * * * *