课件：鲍曼不动杆菌流行及治疗().ppt

* 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。 * * * * * High-dose ampicillin-sulbactam for MDRAB VAP Scand J Infect Dis 2007: 39: 38-43. 0.785 0.303 0.580 0.568 0.936 p value CRAB的治疗-多黏菌素 静脉应用多黏菌素治疗总有效率为57%~80%. 肾功能损害的发生率约为0~37%. 雾化吸入有助于减少全身用药的副作用,并在 局部组织达到较高的药物浓度. 仍需进一步临床对照研究证实. Clin Microbiol Rev 2008: 21: 538-582. A case: PDRAB meningitis cefoperazone/sulbactam 35d Polymyxin E Jian Li, et al. AAC, 2006, 50:2946–2950 Passage of ATCC 19606 in CAMHB with or without colistin Hetero resistant to colistin passages clinic AB in broth containing colistin increased the proportion of the resistant subpopulations from 10E-8 to 10E-4 isolates MIC Before induction After induction* 6mg/L 8mg/L 10mg/L 6mg/L 8mg/L 10mg/L 16301 1.5mg/L 10E-6 10E-6 10E-6 10E-5 10E-5 10E-5 16302 1.5mg/L 10E-8 10E-8 10E-8 10E-4 10E-4 10E-4 10305 1.5mg/L 10E-7 10E-8 10E-8 10E-5 10E-5 10E-5 *8mg/L * 48小时，64mg/L * 48小时 High resistance to colistin of MDRAB from Korea Considering the increasing use of colistin, independent but frequent emergence of colistin resistance in MDRAB is of great concern. Kwan Soo Ko, JAC 2007,60:1163-7 Young Kyoung Parka, DMID 2009, 64:43-51 BIG BUG! Colistin Good outcome to MDR AB infection，including: bacteremia、pneumonia、urinary tract infection、wound infection、 meningitis Only 10.8％ CRAB were resistant to colistin in China Mainland Tigecycline: the saviour? 22 microbiological studies reporting data for 2384 Acinetobacter spp, 90% isolates (including MDR and CRAB) were susceptible 42 severely ill patients, tigecycline therapy (combination with other antibiotics in 28 patients) was effective in 32 cases In 3 cases, resistance to tigecycline developed during treatment Drosos EK, et al. JAC, 2008, 62:44-45 Tetracycline Susceptibility Testing in Isolates of Acinetobacte from a U.S. Military Hospital Kevin S. Akers, AAC, 2009, accepted Susceptibility of 73 IPM-I or R A. baumannii isola