耐甲氧西林金葡菌(MRSA)治疗药物课件.ppt

1、1EuropeEuropeMRSA 28%VRE (E. faecium) 8(22)%S pneumoniae/penicillin15%Jones, RN. Personal Communications, February 2008Jones, RN. Personal Communications, February 2008United StatesUnited StatesMRSAMRSA 54%54%VRE (E.faecium) VRE (E.faecium) 27 (72)%27 (72)%S.pneumoniaeS.pneumoniae/penicillin/penicil

2、lin 15%15%Asia PacificAsia PacificMRSA 42%VRE (E. faecium) 5 (10)%S pneumoniae/penicillin 32%Latin AmericaLatin AmericaMRSA38%VRE (E. faecium) 9 (36)%S pneumoniae/penicillin 13% 2许多报告指出MRSA感染比MSSA感染病死率更高，住院期更长，费用更高，并发症多；(CID2008;46:S344)34CA-MRSAHA-MRSASCCmec、型型、型型生长繁殖（代长）生长繁殖（代长）快（快（29.8min)慢慢 (38.

3、8min)毒素毒素大多产大多产PVL及及溶血素，肠毒素溶血素，肠毒素等等(C,B,H)毒力因子毒力因子产多种毒素，产多种毒素，PVL少见少见药物敏感性药物敏感性对非对非内酰类敏感内酰类敏感多重耐药多重耐药感染部位感染部位SSTI多见，少数肺炎等多见，少数肺炎等各种部位感染各种部位感染寄殖寄殖腋下、腹股沟、会阴，环境等腋下、腹股沟、会阴，环境等鼻腔鼻腔感染感染567891011克林霉素（克林霉素（Clindamycin)Clindamycin)12达托霉素（达托霉素（DaptomycinDaptomycin）13利奈唑胺利奈唑胺 (Linezolid)(Linezolid)14151617181

4、92021抗生素发展时间表临床使用到出现耐药的时间(年)万古霉素从上市到耐药出现万古霉素从上市到耐药出现经历了经历了Clatworthy AE, et al. Targeting virulence: a new paradigm for antimicrobial therapy. Nature chemical biology 2007; 3(9):541-548. 22232425262728Clinical Infectious Diseases 2009; 49:3257Clinical Infectious Diseases 2009; 49:325729 1.Rybak M, L

5、omaest o B,Rotschafer JC,et al. Therapeutic monitory of vancomycin in adult patients: A consensus review of the ASHP, IDSA and the SIDP.Am J Health-Syst Pharm 2009, 66:82-98.2.林东昉、吴菊芳、张婴元等。利奈唑胺与万古霉素治疗革兰阳性菌感染的随机、双盲、对照、多中心临床试验。中国感染与化疗杂志2009,9(1):10-173.Stevens D.L. Herr D, Lampiris H,et al.Linezolid v

6、ersus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections. Clinical Infectious Diseases 2002, 34:1481904.Abad F, CalboF, Zapater P,et al. Comparative pharmacoeconomic study of vancomycin and teicoplanin in intensive care patients.International Journal of Antimicrob

7、ial Agents ,2000,15:65715.Downs NJ, Robert E. Neihart, MD, Jeanette M. Dolezal,et al.Mild Nephrotoxicity Associated With Vancomycin Use.6.Sorrell TC, Collignon PJ.A prospective study of adverse reactions associated with vancomycin therapy.J Antimicrob Chemother. 1985 Aug,16(2):235-41.7.Farbert BF,Mo

8、ellering RC,Retrospective Study of the Toxicity of Preparations of Vancomycin from 1974 to 1981, Antimicrobial agents and chemotherapy. 1983,23(1):138-1418.Levine DP. Vancomycin:A History. Clinical Infectious Diseases 2006, 42:S5-123031 万古霉素杀菌活性优于利奈唑胺135724689101112081624324048566472小时对照组利奈唑胺万古霉素MRS

9、A 细菌数量变化Log10 CFU/gLaPlante KL, et al. Impact of High-Inoculum Staphylococcus aureus on the Activities of Nafcillin, Vancomycin, Linezolid, and Daptomycin, Alone and in Combination with Gentamicin, in an In Vitro Pharmacodynamic Model. Antimicrobial Agents and Chemotherapy 2004; 48(12):4665-4672.对于对

10、于MRSAMRSA感染，万古霉素的杀菌作用感染，万古霉素的杀菌作用维持维持3232小时小时，而利奈唑胺始终只能起到抑制细菌的作用而利奈唑胺始终只能起到抑制细菌的作用32 3334参加单位参加单位n上海华山医院上海华山医院n上海瑞金医院上海瑞金医院n北京协和医院北京协和医院n卫生部北京医院卫生部北京医院n浙医一附院浙医一附院n上海儿科医院上海儿科医院n湖北同济医院湖北同济医院n广州医学院一附院广州医学院一附院n上海市儿童医院上海市儿童医院n重庆医大一附院重庆医大一附院n甘肃省人民医院甘肃省人民医院n新疆医大一附院新疆医大一附院n安徽医科大学一附院安徽医科大学一附院n昆明医学院一附院昆明医学院一附

11、院35年份年份中国中国CHINETCHINET上海耐药性监测网上海耐药性监测网菌株数菌株数G(+)G(+)金葡金葡% %序位序位MRSA%MRSA%菌株数菌株数G(+)G(+)金葡金葡% %序位序位MRSA%MRSA%20052005227742277433.133.129.029.01 169.269.2306353063534.734.732.332.31 165.665.620062006339453394531.831.828.728.71 158.458.4313163131636.436.430.630.61 164.664.620072007360013600134.334.327.427.41 158.058.035.9735.9737.037.032.132.11 161.161.120082008362163621630.530.532.232.21 155.955.9359793597932.232.238.838.81 162.362.320092009436704367029.029.032.532.51 152.752.7371673716730.030.037.337.31 156.556.520102010478504785028.428.432.832.81 151.751.7- -3637 383940