產(chǎn)碳青霉烯酶肺炎克雷伯菌的治療課件

替加環(huán)素能否用于產(chǎn)碳青酶烯酶肺炎克雷伯菌（CRKP）的嚴(yán)重感染微生物中的“收藏家”雖然不是對抗生素天然耐藥，但因為只產(chǎn)適量的青霉素酶染色體，被稱為臭名昭著的“多耐藥質(zhì)粒的收藏家”泛耐藥CRKPClinicalstudies,antimicrobialtherapies,andoutcomesforpatientsinfectedwithKPC-producing

K.pneumoniaeReferenceCountry(yrofpublication)StudydesignNo.ofpatientswithindicatedinfectionTypeofβ-lactamase(no.ofisolates)Treatmentwithactivedrug(no.ofpatients)Outcome(no.ofsuccesses/no.offailures)182USA(2009)Caseseries3BSIsKPC-2(3)Tetracycline-aminoglycoside(1)1/0Colistin(3)1/2175Greece(2010)Case-controlstudy19BSIsKPC-2(19)Colistin(10)2/8162China(2008)Tigecycline-aminoglycoside(1)1/0Colistin-aminoglycoside(9)4/5274Greece(2011)Case-controlstudy53BSIsKPC-2(53)Carbapenem(1)0/1Colistin(7)3/4Tigecycline(5)3/2Aminoglycoside(2)2/0Colistin-aminoglycoside(2)2/0Clinicalstudies,antimicrobialtherapies,andoutcomesforpatientsinfectedwithMβL-producing

K.pneumoniaeReferenceCountry(yrofpublication)StudydesignNo.ofpatientswithindicatedtypeofinfectionTypeofMBL(no.ofisolates)Treatment(no.ofpatients)Outcome(no.ofsuccesses/no.offailures)86Greece(2008)Tigecycline(1)1/056Spain(2008)Tigecycline-colistin(2)1/1269Taiwan(2001)Caseseries3BSIsIMP-8(3)Carbapenem(3)1/2143Taiwan(2004)Caseseries3(2pneumonias,1BSI)IMP-typeenzyme(3)Carbapenem(1)1/0240Greece(2008)Caseseries17(14BSIs,3pneumonias)VIM-1(17)Colistin(6)6/0Tigecycline(1)0/1175Greece(2010)Case-controlstudy18BSIsVIM-1(17)Colistin(10)6/4VIM-typeenzyme(1)Colistin-aminoglycoside(8)4/467Greece(2009)Prospectiveobservationalstudy67BSIsVIM-1(67)Carbapenem(14)11/3Carbapenem-colistin(8)8/0Colistin(15)11/4Noactivedrug(18)13/5RegimenA,combinationtherapywith≥2activedrugs,oneofwhichwasacarbapenem;regimenB,combinationtherapywith≥2activedrugs,notincludingacarbapenem;regimenC,monotherapywithanaminoglycoside;regimenD,monotherapywithacarbapenem;regimenE,monotherapywithtigecycline;regimenF,monotherapywithcolistin;regimenG,inappropriatetherapy.RegimenAwassuperiortoregimensB,E,F,andG(forAversusB,E,F,andG,the

Pvaluewas0.02,0.03,<0.0001,and<0.0001,respectively).RegimensB,C,andDweresuperiortoregimenG(forBversusG,

P

=0.014;forCversusG,

P

=0.04;andforDversusG,

P

=0.03).

TigecyclinedemonstratesmainlybacteriostaticactivityagainstGram-negativeorganisms,andtheattainabledrugconcentrationsatseveralanatomicsitesaresuboptimal.替加環(huán)素對革蘭氏陰性菌主要是抑菌效果theattainabledrugconcentrationsatseveralanatomicsitesaresuboptimal在體外藥效學(xué)模式中，隨著濃度超過1mg/L時，其抑菌作用保持不變，因此實現(xiàn)藥物濃度是次重要的Thedrugconcentrationsattainablebythisstandarddosingregimen,combinedwiththisdrug'sMICprocurrentCPEisolates,renderitunlikelyfortigecyclinetocureCPEinfectionsatanatomicsiteswheredrugconcentrationsaresuboptimal.替加環(huán)素在某些部位濃度很低，且不足以達(dá)到抑菌濃度。當(dāng)CPE感染在這些部位時，則很難達(dá)到療效。這使得替加環(huán)素不太可能治愈CPE在這些部位的嚴(yán)重感染謝謝聆聽！參考文獻(xiàn)產(chǎn)碳青霉烯酶肺炎克雷伯菌的耐藥基因及流行病學(xué)研究進(jìn)展Carbapenemasesin

Klebsiellapneumoniae

andOther

Enterobacteriaceae:anEvolvingCrisisof