耐药菌的几个概念

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,耐药菌的几个概念,抗生素,Antibiotic,抗微生物药物,Antimicrobial agents,抗菌药抗病毒药,抗菌药物,Antibacterial agents,抗生素合成抗菌药,抗感染药物,Anti-infectives,抗微生物药抗寄生虫药,几个概念,临床常用抗菌药物,-内酰胺类-lactams抗生素,氨基糖苷类Aminoglycesides抗生素,大环内酯类Macrolides抗生素,喹诺酮类Quinolones药物,糖肽类Glycopeptides 抗生素,恶唑烷酮类Oxazolidine,其他类抗菌药物,通用定义：对三种以上不同类别的抗菌药物耐药的细菌,多重耐药菌MDR：不同菌种,定义不完全一致,多重耐药菌Multidrug-resistance)：,对以下3类抗菌药物耐药,抗假单胞菌头孢菌素头孢他啶、头孢吡肟,抗假单胞菌碳青霉烯类抗生素亚胺培南、美罗培南,含有内酰胺酶抑制剂的复合制剂,氟喹诺酮类,氨基糖苷类,Clin Infect Dis,2006;43 Suppl 2:S43-8,Clin Microbiol Rev,2008;21:538-82,N Engl J Med,2008;358:1271-81,针对主要非发酵菌,MDR-PDR-XDR,MDR,Multi Drug Resistant,PDR,Pan Drug Resistant,(,泛耐药,),XDR,Extensive Drug Resistant,(,大量,/,广泛,/,大规模耐药,),Extreme Drug Resistant,(,极端,/,极度耐药,),XDR vs XDR,XDR,Text,resistance to all but 1 or 2,Extensive Drug Resistant,Extreme Drug Resistant,complete,loss of antibiotic options,Matthew E.Falagas,et al.CID 2021:46(1):1121-1122,David L.Paterson,et al.CID 2007:45(1):1179-1181,MDR XDR PDR,XDR,PDR,XDR,MDR,Extreme drug resistant,Pan drug resistant,Extensive drug resistant,Multi drug resistant,XDR,PDR,MDR,resistance to,3 classes of antimicrobial agents,resistance to all but 1 or 2,resistance to all,among those,drugs,available at the time,in most parts of the world,potentially effective,Matthew E.Falagas,et al.CID 2021:46(1):1121-1122,Antipseudomonal penicillins,Cephalosporins,Carbapenems,Monobactams,Quinolones,Aminoglycosides,Polymyxins,PDR,P.aeruginosa,A.baumannii,Antipseudomonal penicillins,Cephalosporins,Carbapenems,Monobactams,Quinolones,Aminoglycosides,Polymyxins,Sulbactam,Tetracycline,Tigecycline,Matthew E.Falagas,et al.JMM,2006,55,16191629,当今世界主要的,MDR,、,XDR,、,PDR,1.,甲氧西林耐药金葡菌,(MRSA),2.,万古霉素耐药肠球菌,(VRE),和金葡菌,(VRSA),3.,产超广谱,-,内酰胺酶,(ESBLs),大肠埃希菌和肺炎克雷伯菌,4.,高产头孢菌素酶肠杆菌科细菌,5.,多重耐药 耐药,铜绿假单胞菌和鲍曼不动杆菌,多重耐药菌流行时期,感染治疗,有效性,细菌耐药性,增加,细菌耐药的现状,40,年代,纯化获得青霉素,60,年代研制成,第一代头孢菌素,各种,-,内酰胺类抗生素,广泛应用于临床,真菌或时机菌,特别是三代头孢的广泛应用，针对各种抗生素的耐药菌显著增多,几十年来抗生素,的进一步开发,VRE,MRSA,AmpC,ESBLs,医院内耐药菌株的变迁,1920,链球菌,葡萄球菌,阴性杆菌,MRCNS,MRSA,ESBL,念珠菌属,VRE,AmpC,1960,1970,1990,2000,抗菌药物的耐药机理,膜蛋白的缺失或数量的减少,产生灭活酶或钝化酶,靶位改变,主动外运,细菌生物被膜的形成,