1、1EuropeMRSA 28%VRE(E.faecium)8(22)%S pneumoniae/penicillin 15%Jones,RN.Personal Communications,February 2008United StatesMRSA 54%VRE(E.faecium)27(72)%S.pneumoniae/penicillin 15%Asia PacificMRSA 42%VRE(E.faecium)5(10)%S pneumoniae/penicillin 32%Latin AmericaMRSA38%VRE(E.faecium)9(36)%S pneumoniae/pen
2、icillin 13%23456常常人人中中C CA A-M MR RS SA A的的带带菌菌率率0 0.4 4%；另另一一项项调调查查：医医院院内内M MR RS SA A感感染染者者中中约约8 8-2 20 0%由由C CA A-M MR RS SA A引引起起，年年发发病病率率2 25 5.7 7/1 10 0万万；无无危危险险因因素素的的健健康康儿儿童童中中带带菌菌率率0 0.8 8-3 3.0 0%；美美国国C CD DC C报报告告：2 20 00 05 5年年社社区区和和医医院院中中发发生生的的M MR RS SA A感感染染中中分分别别有有2 22 2.2 2%和和1 15 5
3、.7 7%的的菌菌株株为为C CA A-M MR RS SA A；近近期期有有报报道道医医院院中中C CA A-M MR RS SA A感感染染暴暴发发流流行行；7恶恶唑唑烷烷酮酮类类；替替加加环环素素；达达托托霉霉素素；脂脂糖糖肽肽类：类：D Da al lb ba av va an nc ci in n，T Te el la av va an nc ci in n，O Or ri it ta av va an nc ci in n；新新头头孢孢菌菌素：素：C Ce ef ft to ob bi ip pr ro ol le e，c ce ef ft ta ar ro ol li in ne
4、 e；新新碳碳青青霉霉烯烯类：类：r ra az zu up pe en ne em m；二二氢氢叶叶酸酸还还原原酶酶抑抑制制剂：剂：I Ic cl la ap pr ri im m891011克林霉素（克林霉素（Clindamycin)12达托霉素（达托霉素（Daptomycin）13利奈唑胺利奈唑胺(Linezolid)1415161718192021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 antimicro
5、bial therapy.Nature chemical biology 2007;3(9):541-548.22232425262728Clinical Infectious Diseases 2009;49:325729 1.Rybak M,Lomaest 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、
6、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 versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections.Clinical Infectious Diseases 2002,34:1481904.Abad F,CalboF,Zapater P,et al.Comparative ph
7、armacoeconomic study of vancomycin and teicoplanin in intensive care patients.International Journal of Antimicrobial 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
8、reactions associated with vancomycin therapy.J Antimicrob Chemother.1985 Aug,16(2):235-41.7.Farbert BF,Moellering 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 I
9、nfectious 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MRSA 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
10、Vitro Pharmacodynamic Model.Antimicrobial Agents and Chemotherapy 2004;48(12):4665-4672.对于MRSA感染，万古霉素的杀菌作用维持32小时，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院353637 383940
