ESBLs肠杆菌科细菌感染的治疗ppt课件

– First described in Germany (1983) and France (1985) among Klebsiella spp
产ESBLs肠杆菌科细菌感染的治疗
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社区获得感染ESBLs流行情况
Henan
Beijing
Shanghai
1. 2002-2003年
2. 中国7个地区 3. 社区获得性感染
产ESBLs肠杆菌科细菌感染的治疗北京协和医院杨启文教授1提4 供
产ESBLs比例（Chinet监测2005-2012）
11% 3% 1% 4% 6%
49%
9%
17%
产ESBLs肠杆菌科细菌感染的治疗
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腹腔社区感染肠杆菌科细菌产ESBLs
Asia-Pacific Region（SMART 2007）
产ESBLs肠杆菌科细菌感染的治疗
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大肠埃希菌和肺炎克雷伯菌的ESBLs发生率
SMART, 2002-2012, IAI, China
Salmonella (in some countries)
ESBLs are rare in:
• Pseudomonas aeruginosa
• Acinetobacter baumannii
– PER-type and OXA-type enzymes are more common in Pseudomonas eruginosa and Acinetobacter spp.
??
Imipenem
0
0
0
0
Ertapenem
0
0
0
0
Cefotaxime
14.7
14.4
15.4
25.1
Ceftazidime
(5.9)
(2.7)
(8.1)
20.0
Pip/taz
9.5
7.1
13.2
21.7
Ciprofloxacin
40.8
50.6
25.2
产ESBLs肠杆菌科细菌感染的治疗
Antimicrob Agents Chemother. 2006 Jan;50(1):374-8.
医院革兰阴性菌感染肠杆菌科细 菌50%-60%
94.97
100 90 80 70 60 50 40 30 20 10 0
2010
95.96
2011
97.43
2012
非发酵菌 肠杆菌科细菌
浙江大学医学院附属邵逸夫产医E院SBLs肠杆菌科细菌感染的C治H疗INET 2010-2012
3
肠杆菌科细菌
最需关注的-内酰胺酶是ESBLs
Laboratory, Health Protection Agency, Colindale, London
产ESBLs肠杆菌科细菌感染的治疗
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Species Distribution of GNB Causing IAIs
2,292 Isolates, China, SMART, 2002-2007
• 是一类由质粒介导的2be类-内酰胺酶，能水解氧亚氨 基-内酰胺抗生素，大多数能被-内酰胺酶抑制剂如 克拉维酸（CA）所抑制。
N
C C NH
S
+NH3
N
N
S
O
O
CH3
头孢噻肟产、ES头BLs孢肠杆他菌科啶细、菌感头染的孢治疗吡肟等
R COO-
5
Common ESBL producers:
• Klebsiella pneumoniae • Escherichia coli • Proteus mirabilis • Enterobacter cloacae • Non-typhoidal
产ESBLs肠杆菌科细菌感染的治疗
感染科 俞云松
产ESBLs肠杆菌科细菌感染的治疗
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社区革兰阴性菌感染肠杆菌科细菌
2% 1% 1% 2% 4% 6%
8%
>70%
46%
E. coli
Klebsiella spp.
Pseudomonas aeruginosa
Enterobacter spp., Serratia spp., and Citrobacter spp. Acinetobacter spp.
22.9
8
ESBLs – an emerging problem
Glasswell et al, Healthcare-associated Infection and Antimicrobial Resistance Dept & Antimicrobial Resistance Monitoring and Reference
产ESBLs肠杆菌科细菌感染的治疗
北京协和医院杨启文教授提供
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Data not published
大肠埃希菌ESBLs发生率(HA vs CA)
wk.baidu.comP=0.001 P<0.001
产ESBLs肠杆菌科细菌北感染京的协治和疗医院杨启文教授提供 13
肺炎克雷伯菌ESBLs发生率(HA vs CA)
P=0.177 P=0.404 P=0.181
Escherichia coli Pseudomonas aeruginosa Acinetobacter baumannii Stenotrophomonas maltophilia
Klebsiella pneumoniae Enterobacter cloacae Citrobacter freundii others
ESBLs是肠杆菌科细菌最重要的耐药机制
•超广谱-内酰胺酶(ESBLs) •高产头孢菌素酶(AmpC酶)
MDR
•极少数菌株产碳青霉烯酶 (碳青霉烯酶KPC)
产ESBLs肠杆菌科细菌感染的治疗
XDR or PDR
4
超广谱-内酰胺酶（extended spectrum lactamases，ESBLs）
Proteus mirabilis
Indole-positive Proteus spp. 13%
Other nonfermenters
Stenotrophomonas maltophilia
17%
Others
Antimicrob Agents Chemother. 2006 Jan;50(1):374-8.
Wuhan
病人分离的革兰
阴性菌共2099
株
产ESBLs肠杆菌科细菌感染的治疗
Zhejiang
Hong Kong Guangzhou
7
肠杆菌科细菌产ESBLs
ESBL +
All (1651)
??
E. coli (953)
16
Klebsiella (357)
17
Enterobacter Citrobacter, Serratia (175)