重症肺部感染诊治策略(南昌)[可修改版ppt]

肺部感染
200
Baidu Nhomakorabea180
mortality (per10 000)
160
140
抗生素时代肺炎
120
死亡率明显下降
100
80
60
40
20
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Mortality Trends with Pneumonia from 1900 to 1990 in USA
Percent Resistance 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Nosocomial Antimicrobial Resistance
Methicillin (oxacillin)-resistant Staphylococcus aureus
Percent Resistance 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Percent Resistance 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
60
50
40
Percent %
30
20
10
0 2000
2001
2002
2003
2004
E.coli
Klebsiella.spp
2005
2006
上海大肠埃希菌对FQ耐药性持续增高
%
70
CIP
60
50
40
30
20
10
60 50 40 30 20 10 0
Vancomycin-resistant enterococci
30 25 20 15 10 5 0
Non-Intensive Care Unit Patients Intensive Care Unit Patients
Source: National Nosocomial Infections Surveillance (NNIS) System
Nosocomial Antimicrobial Resistance
3rd generation cephalosporinresistant Klebsiella pneumoniae
14 12 10 8 6 4 2 0
Fluoroquinolone-resistant Pseudomonas aeruginosa
aztreonam
norfloxacin
imipenem
cefotaxime
clavulanic ac.
cefuroxime
gentamicin
cefalotina
nalidíxico ac.
ampicillin
methicilin
vancomicin
rifampin
chlortetracyclin
Community-Acquired MRSA
– CA strains – genetically and clinically different than HA-MRSA
– CA-MRSA - Type IV SCCmec
• Resistance to beta-lactams, erythromycin • Sensitive to septra, clindamycin
Semin Respir Infect 9(3):140-52，1994
1928年Alexander Fleming发现青霉 素，1941年正式作为药物应用于临 床，标志抗生素时代的开始
1944年发现链霉素，1952年红霉素 问世;60～70年代后， β-内酰胺及喹 诺酮类开发和应用，抗生素“大爆 发”。目前投入市场超过200种
重症肺部感染诊治 策略(南昌)
感染与挑战
世界人口死因
---感染性疾病：32.7%
“人类正出于世界性传染性 疾病的边缘任何国家都不 能幸免”
（WHO总干事：布伦特兰女士 )
肺部感染概述
肺部感染现状与面临的问题…
肺部感染现状
肺部感染现状
肺部感染近年来显著增多
➢ HIV/AIDS ➢ 恶性肿瘤放化疗 ➢ 器官移植 ➢ 免疫系统疾病 ➢ 社会人口老龄化
由于经过药物治疗 敏感菌株已灭绝， 突变菌株被选择,
耐药克隆株 在曾经敏感 的菌群内生 长,
Sanders CC, Sanders WE. J Infect Dis 1986;154:792-800
在治疗过程中， 耐药性逐渐出现 临床表现.
Percent Resistance 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
streptomycin
pencillin G
prontosil
1920 19129030 19139040 19149050 19501961096019710970 19810980 19199090 22000000
Transference of vanA gene from E. faecalis to S. aureus
Antibiotic resistance: genetic events
Susceptible Bacteria
Resistant Bacteria
Mutations
Resistance Gene Transfer New Resistant Bacteria
由于选择作用而发生的耐药
药物治疗
自发性突变发 生于缺乏药物 选择的敏感菌 群内，
Development of anti-infectives
ertapenem
tigecyclin
daptomicin
The development
linezolid telithromicin
quinup./dalfop.
of anti-infectives …
cefepime ciprofloxacin
30 25 20 15 10 5 0
Non-Intensive Care Unit Patients Intensive Care Unit Patients
Source: National Nosocomial Infections Surveillance (NNIS) System
上海地区ESBLs发生率逐年上升