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1、1,挑战“超级细菌” 延缓细菌耐药,今天不采取行动，明天无药可用,全球关注的多重耐药菌,MRSAVRE产ESBL的肠杆菌科菌产NDM-1,KPC,IMP,VIM等的肠杆菌科菌CR ABA,MRSA在中国大陆：CHINET 2009,汪复等. 2009年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2010; 10(5):325-334.,Regional Trends in MRSA Rates (SENTRY Program, 1997-2008; GPRS,2005-2009),抗生素的耐药发展史，新药迅速耐药值得重视,Clatworthy AE, et al. Targeting
2、 virulence: a new paradigm for antimicrobial therapy. Nature chemical biology 2007; 3(9):541-548.,2006-2009年监测数据 耐万古霉素的粪肠球菌与屎肠球菌发生率极少,细菌耐药率 (%),20061CHINET (N=2621),20072CHINET (N=2634),20084CHINET (N=2859),2006-20073MOH (N=7528),1. 汪复. 2006年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2008; 8(1):1-9.2. 汪复等. 2007年中国C
3、HINET细菌耐药性监测. 中国感染与化疗杂志 2008; 8(5):325-333.3. 肖永红等. 2006-2007年Mohnarin细菌耐药检测. 中华医院感染学杂志 2008; 18(8):1051-1056.4. 汪复等. 2008年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2009; 9(5):321-329. 5. 汪复等. 2009年中国CHINET细菌耐药性监测. 中国感染与化疗杂志 2010; 10(5):325-334.,20095CHINET (N=3369),2006-2007年5月9株VRE共分为6个克隆（A型-F型），为多克隆传播，其中VRE2、VR
4、E8和VRE9同属于A型，VRE3和VRE4同属于B型。,王贺 徐英春 等 中国医学科学院学报，2008；30（5）：521-524,The clinical information, genotype of 9 isolates (2006-2007年5月),王贺 徐英春 等 中国医学科学院学报，2008；30（5）：521-524,全球关注的多重耐药菌,MRSAVRE产ESBL的肠杆菌科菌产NDM-1,KPC,IMP,VIM等的肠杆菌科菌CR ABA,E. coli ESBL APAC region (SENTRY),Farrell DJ, et al., J Infection (201
5、0);60:440-51,SMART：产ESBLs菌感染的临床和经济学结果,设计: 在腹腔感染 (IAI) 住院患者中进行一项回顾性研究场所: 中国参与SMART的6家机构方法: 通过微生物学分析确定所有产ESBLs分离株和抗生素敏感性主要目标: 回顾性评价感染产ESBLs菌的住院患者中感染缓解和卫生保健资源使用情况,Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010, 14431449,ESBLs患者起始抗生素治疗成功率较低,0,20,40,60,80,100,百分比,82%,58%,起始抗生素的
6、治疗成功率2,b,P=0.016,ESBLs (+),ESBLs (-),n=54 n=31,主要研究目标是回顾性评价感染产ESBL菌的住院患者中感染缓解和卫生保健资源使用情况。ESBLs阳性组和 ESBLs阴性组患者的起始抗生素治疗成功率分别为 58.1% (18/31)和 81.5%(44/54),Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010, 14431449,ESBLs患者住院时间延长,0,5,10,15,20,25,天数,14.5,24.5,住院时间,P0.001,ESBLs (+),
7、ESBLs (-),n=54 n=31,Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010, 14431449,ESBLs患者治疗费用增加,人民币(元),ESBLs (+),ESBLs (-),P=0.052,P=0.004,总住院费用,静脉用抗生素的费用,15217.5,21498.4,1869.9,4320.2,n=54 n=31,n=51 n=26,Bijie Hu, et al. Current Medical Research & Opinion Vol. 26, No. 6, 2010,
8、14431449,人民币(元),15,16,How about SMART global currently?,Approaching 200 sites in 58 countriesAsia/Pacific: 54Europe: 53Latin America: 38North America: 28MEA: 25Each site to collect 100 IAI and 50 UTI each year25-30,000 isolates per year added to database of 70,000,17,SMART China _ 10 years history,H
9、ospital list of SMART China,The distribution of isolates from IAI in China from 2002-2009,49.2%,66.1%,Yang et al. International Journal of Antimicrobial Agents 36 (2010) 507512,Results : Increase of ESBL_E.Coli/K. Pneunoniae in China (IAI) from 2002 to 2009,Yang et al. International Journal of Antim
10、icrobial Agents 36 (2010) 507512,% ESBL-Producing E. coli SMART, 2002-2009, IAI, ChinaCommunity Onset vs. Hospital Onset,Qiwen yang，yingchun xu etal，international J antimicrob Agents ，2010,36:507-512,23,Results 3: Trends in the susceptibility of Enterobacteriaceae in China from 2002 to 2009,Yang et
11、al. International Journal of Antimicrobial Agents 36 (2010) 507512,24,SMART Asia-Pacific Map,25,ESBL-producing E.Coli/K.Pneumoniae in IAI are common, especially in China and India,1/3,1/4,P.-R. Hsueh et al. / International Journal of Antimicrobial Agents 36 (2010) 408414,26,The susceptibility of EPM
12、 、IMP and PTZ to isolates of IAI is high in AP (2008),P.-R. Hsueh et al. / International Journal of Antimicrobial Agents 36 (2010) 408414,ESBL/AmpC+ 孔通道缺失,产IMP4/8菌株,产KPC-2菌株,碳青霉烯耐药肠杆菌科地域分布(2004-2008),What other drugs can we test if isolate is “R” to all drugs that might be used for Enterobacteriacea
13、e?,黏菌素 /多粘菌素 敏感MIC 2 g/ml S 替加环素 可能敏感 MIC 2 g/ml S,52,Genetic characteristics of blaKPC-2-carrying K. pneumoniae from China during 2009 SENTRY Program,Yao Wang1, Lalitagauri M. Deshpande2, Rodrigo E. Mendes2, YunSong Yu3, Yingchun Xu1, Minjun Chen1, David J. Farrell2, Ronald N. Jones21Peking Union M
14、edical College Hospital, Beijing, China2JMI Laboratories, North Liberty, IA, USA3 The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China,Results,9 isolates (5.5%) from 10 sites with elevated imipenem and/or meropenem MICs (2 g/ml)6 isolates from Hangzhou were MHT
15、positive and blaKPC positive.Sequence: KPC-2 encoding gene,PFGE and MLST,PFGE: SpeI digestionClone A: 4 isolates with 3 subtybes (ICU)-ST 11Clone B: 2 isloates (neurological ward)-ST 65,SEANIR2008：大肠埃希菌和肺炎克雷伯菌的药物敏感性,注：头孢噻利仅测试大肠埃希菌和肺炎克雷伯菌各68株。,头孢塞利与其他药物联合或单药的抑菌效果,赵颖，徐英春等，中国感染与化疗杂志 待发表,头孢塞利与其他药物联合抑菌效果
16、,赵颖，徐英春等，中国感染与化疗杂志 2011待发表,联合用药：,铜绿假单胞菌折点与给药剂量信息,CLSI M100-S21. 2011,寻找新的酶抑制剂： NXL104,NXL104 is a novel -lactamase inhibitor that inhibits AmpC, as well as ESBL and KPC enzymesBeing studied in combination with both ceftaroline and ceftazidime,新酶抑制剂+新头孢菌素Ceftaroline with NXL104,Sader HS, et al. IDSA 2010; poster 214,结论,MRSA：中国有下降的趋势 万古霉素+头孢塞利联合有较高的相加作用VRE：平均发生率较低E.Coli和K. pneumoniae：腹腔感染分离率高，且产ESBL菌株快速增长，三四代头孢菌素敏感率持续下降 、但避免过量使用碳青霉烯类，体外敏感可选头孢塞利，头孢他啶，哌拉西林-他唑巴坦，头孢哌酮-舒巴坦，头孢美唑铜绿假单胞菌：折点与计量，或联合有较高的协同与相加作用 碳青霉烯类耐药的菌株发生率平均较低，注意医院感染控制：隔离间医护洗手含氯消毒液消毒环境护理员及探访家属洗手,39,谢谢！,
