产ESBLs肠杆菌科细菌感染以及治疗

Klebsiella pneumoniae Enterobacter cloacae Citrobacter freundii others
11% 3% 1% 4% 6%
49%
9% 17%
腹腔社区感染肠杆菌科细菌产ESBLs
Asia-Pacific Region（SMART 2007）
大肠埃希菌和肺炎克雷伯菌的ESBLs发生率
Laboratory, Health Protection Agency, Colindale, London
Species Distribution of GNB Causing IAIs
2,292 Isolates, China, SMART, 2002-2007
Escherichia coli Pseudomonas aeruginosa Acinetobacter baumannii Stenotrophomonas maltophilia
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
CHINET 2010-2012
3
肠杆菌科细菌
最需关注的-内酰胺酶是ESBLs
ESBLs是肠杆菌科细菌最重要的耐药机制
N
C C NH
S
+NH3
N
N
S
O
O
ቤተ መጻሕፍቲ ባይዱCH3
头孢噻肟、头孢他啶、头孢吡肟等
R COO-
Common ESBL producers:
• Klebsiella pneumoniae • Escherichia coli • Proteus mirabilis • Enterobacter cloacae • Non-typhoidal
ESBLs – an emerging problem
Glasswell et al, Healthcare-associated Infection and Antimicrobial Resistance Dept & Antimicrobial Resistance Monitoring and Reference
产ESBLs肠杆菌科细菌感染以及治疗
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.
Wuhan
Shanghai
Zhejiang Hong Kong Guangzhou
肠杆菌科细菌产ESBLs
ESBL + Imipenem Ertapenem Cefotaxime Ceftazidime Pip/taz Ciprofloxacin
All (1651)
?? 0 0 14.7 (5.9) 9.5 40.8
Proteus mirabilis
Indole-positive Proteus spp. 13%
Other nonfermenters
Stenotrophomonas maltophilia
17%
Others
Antimicrob Agents Chemother. 2006 Jan;50(1):374-8.
•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)
XDR or PDR
超广谱-内酰胺酶（extended spectrum lactamases，ESBLs）
• 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。
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.
%
（主要是院内分离菌）
70
大肠埃希菌
肺炎克雷伯菌
60
59
54.6 57.8
60 60.2 60.2 61.3 51.5
50
45.7 47.7
45.7
40
34.9
40.4 36.6
38
40.6
30 282.56.7
20
10
0
Wang 2H0, 0C1hen2M0.0D2iagn2o0s0M3icro2b0io0l 4Infec2t0D0is5, 2020050, 561, 220010-2708 2008
– First described in Germany (1983) and France (1985) among Klebsiella spp
社区获得感染ESBLs流行情况
Henan
Beijing
1. 2002-2003年
2. 中国7个地区
3. 社区获得性感染 病人分离的革兰 阴性菌共2099 株
北京协和医院杨启文教授提供
产ESBLs比例（Chinet监测2005-2012）
60.0% 50.0% 40.0% 30.0% 20.0% 10.0%
0.0% 2005 2006 2007 2008 2009 2011 2012
E. coli K. pneumoniae
15
我国耐药监测ESBLs的发生率
E. coli (953)
16 0 0 14.4 (2.7) 7.1 50.6
Klebsiella (357)
17
Enterobacter Citrobacter, Serratia (175)
??
0
0
0
0
15.4
25.1
(8.1)
20.0
13.2
21.7
25.2
22.9
Antimicrob Agents Chemother. 2006 Jan;50(1):374-8.
SMART, 2002-2012, IAI, China
北京协和医院杨启文教授提供 Data not published
大肠埃希菌ESBLs发生率(HA vs CA)
P=0.001 P<0.001
北京协和医院杨启文教授提供
肺炎克雷伯菌ESBLs发生率(HA vs CA)
P=0.177 P=0.404 P=0.181