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1、多重耐藥鮑曼不動桿菌感染的治療OUTLINE不動桿菌在臨床分離菌中的比例不動桿菌的耐藥性問題不動桿菌感染的抗菌治療ConfusionofMDR,XDR,PDRdefinitionsThedefinitionsofMDR,XDR,PDRaresomewhatconfusing:ThereisnoorganizationorassociationresponsibleforgivingthedefinitionsDifferentdefinitionsofPDRaremadebydifferentpro
2、fessionalpersonsXDRisusedforbothMycobacteriumtuberculosisandcommonbacteriaTherapidincreasingofbacterialresistancechangesthedefinitionsuchasMDRControversyofdefinitionsbetweenPatersonandFalagasinCIDFalagasM,CID2008;46:1121PatersonD,CID2008;46:1122Univ.of
3、QueenslandCentreforClinicalResearch,AustraliaAlfaInstituteofBiomedicalSciences,GreeceTuftsUniv.MA,USASemanticdifferenceof“X”inXDRExtensiveDrugResistance(Extensivelydrug-resistant)(XDR)forM.tuberculosis1andcommongram-negativebacilli2ExtremeDrugResistanc
4、e(XDR)forcommonGNB3MMWRMorbMortalWklyRep2006;55:301FalagasM,CID2008;46:1121PatersonDL,CID2007;45:1179DefinitionsofMDR,XDR,PDRbyFalagasDefinitionsofPDR,XDRandMDR:多重耐藥MDR(multidrugresistance):resistance≥3classesofantimicrobials極度耐藥XDR(extensivedrugresist
5、ance):resistancetoallbut1or2泛耐藥PDR(pandrugresistance):resistancetoALLWhyPDRdefinedasresistanttoallantimicrobials?Theprefix“pan-”means“all”or“whole”Semantically,“extreme”(firstusedinthefieldofoncology/hematology)cannotbemoreinclusivethan“pan-”FalagasM,C
6、ID2008;46:1121DefinitionofXDR(ExtremeDrugresistance)forGNBbyPatersonLackingsusceptibilityto:β-lactams:Cefepime,Ceftazidime,Imipenem,Meropenem,Piperacillin/tazobactamQuinolones:Ciprofloxacin,Levofloxacinplusto:Ticarcillin-clavulanate,Ampicillin-sulbacta
7、mAminoglycosidesincludingamikacinTigecyclinePolymyxins(colistinandpolymyxinB)PatersonDL,CID2007;45:1179EqualtothedefinitionofPDRbyFalagas常見糖非發(fā)酵菌Non-fermenters假單胞菌屬銅綠假單胞菌Pseudomonasaeruginosa不動桿菌屬鮑曼不動桿菌Acinetobacterbaumannii窄食單胞菌屬嗜麥芽窄食單胞菌Stenotrophomona
8、smaltophilia產(chǎn)堿桿菌屬糞產(chǎn)堿桿菌Alcaligenesfaecalis伯克霍爾德菌屬洋蔥伯克霍爾德菌Burkholderiacepacia黃桿菌屬(金黃桿菌屬)腦膜敗血黃桿菌Flavobacteriummeningosepticum（腦膜敗血金黃桿菌Chryseobacteriummeningosepticum）上海地區(qū)糖非發(fā)酵菌 在革蘭陰性桿菌比例的上升趨勢(WangF,etal.IntJAntimicrobAgents2003;22:444)Year革
