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李忠思: 广东医学院药理学教授、主任药师。 中国新药临床评价专业委员会委员。 《 中国药师 》《 中国抗生素杂志 》 编委。 获多项国家级项目奖励。 PowerPoint PPT Presentation


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李忠思: 广东医学院药理学教授、主任药师。 中国新药临床评价专业委员会委员。 《 中国药师 》《 中国抗生素杂志 》 编委。 获多项国家级项目奖励。 主要从事临床药理研究、抗生素新药开发与研究。. 我国革兰阳性致病球菌 的耐药现状及防治对策. 李忠思. 一、由于致病微生物耐药 导致感染性疾病治疗 重新成为世纪难题 !.

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李忠思: 广东医学院药理学教授、主任药师。 中国新药临床评价专业委员会委员。 《 中国药师 》《 中国抗生素杂志 》 编委。 获多项国家级项目奖励。

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!


1982199240%89%199213000199596%1998603702050500050

30%8

..

http://www.gov.cn/jrzg/2005-11/29/content_112705.htm


MRSA

20071016(MRSA)95000MRSA


1) , 2) (PSMs), , 3), HIV

MRSA, 18000, 2005(AIDS)16000


1004001.2245102


1998

1998WHA,

2005WHA

2002

21



(intrinsic resistance)(acquired resistance)(natural spectrum)


selective pressure

1300(400)150


811


811NDM-1--1NDM-IDNA(MRSA)NDM-1

8133NDM-150



!



MRSAVRE1inezo1id

!

!



2002-200314675

390,57.8% (390 /675) ,166,117 , 56 , 51 ;

315, 32.6% (220 /675) , 251,58,6 ;

52,7.7%(52 /675) ,34,18 ;

13 ,1.9% ( 13 /675) ,:4,4,2,21

20053283


2003


2007 CHINET


2008 CHINET


20809010


2002


1995~2001,,, ()

2005156


1991~2000

20027258214


73.8%

79.9%

87.6%

1992 -2000


2002 ~2006 3455

2006 17 10


1996-2004

2005926(9)


2001-2006 458


2164

200434345347334


2004




2002

2004 1 27 1


2002

2004 1 27 1


2007CHINET


2008CHINET


2008CHINET


2008CHINET


2008CHINET


2008


2008


2008


2008


2005 2007

Chin J Lab Diagn ,April ,2008 ,Vol 12 ,No. 4


2001-2006 458


20062007


20022004 736

Chin J Lab Diagn ,December ,2005 ,Vol 9 ,No. 6



238,(MRSA) 37.4% HAIMRSA89.2%,CAIMRSA30.2%


2003 3 10 83 5


()

Chin J Nosocomio1 Vo115 No6 2005


MRS)

2080MRS)90MRS


1982MRSA ,1MRSAHA-MRSA2090 ,MRSACA-MRSA , ,1999CDC4CA-MRSA,3 () ,CA-MRSA,


5000CA-MRSA0.4%MRSA0.8%3% CA-MRSA 19901997CA-MRSA1%8%19992001CA-MRSA14

Nai-mi1100MRSA( PFGE ) ,2%CA-MRSA ,85%HA-MRSA;5%CA-MRSA19961998354CA-MRSA ,PFGE84%,86%PFGEHA-MRSA ,CA-MRSAHA-MRSACA-MRSA


Medscapecoml210(Ann Emerg Med2005)(MRSA)(MRSA)AlamedaFrazee


Frazee11975MRSA


CDCCHageman MHSMRSA1715MRSA6521

Hageman91715(88)MRSA206


CA-MRSA


CA-MRSA , ,:CA-MRSA;CA-MRSAHA-MRSAMSSA;;CA-MRSACA-MRSA , ,


MRSA

MRSE

MRCNS

PRSP

VRE


1MRSA

1959G

1961JevensMRSAMRSA2080MRSA

90MRSAMRSA80


MRSA190MRSA

19771979MRSA51985198624 199050199360 199864 200765.1

MRSA8090


MRSA2MRSA

60MRSAMRSAMethicillinMRSA60-80%


MRSA28

2003310835


MRSA3MRSA

  • 1999~2000MRSA

    59.2%161/272

    39.9%105/263

    ----2002183185-187


2004, ,

MRSAMRCNS63.9%82.9%VISA,VRSAVRE

200583054


  • 19936~19947MRSA77.9%80.6%HAI

    ----199662114~116


MRSA70.8%

---- 2003147~48

MRSA71.88%

---- 2002.12 7549~550


()

(MRSA)29.9%;(MRCNS)31.3%MRSAMRCNS

ChinJNosocomiolVol.15No.92005


MRSA4MRSA

SMZ

3335


2MRCNSMRSE

(coagulase negative staphylococci,CNSCoNS),,


CNS,CNS32,16,,,CNS70%,


CNS

,,2080,CNS,CNS,,,,,,


(CRI),,8597,CNS,


,428,248(57.94%),,CNS1880304,CNS,40.8%,CNS


,CNS,CNS,,,


MRCNSMRSE

2000MRCNS79.1%

2002(MRCNS)75.3%


MRCNSMRSE

MRCNS869MRCNS75%(652/869)3,,89.119.229.646.956.3%64.5%86.3%100%"

38 3 ,


3VRE

1986(Vancomycin Resistant Enterococcus VRE)VREVRE1990VRE


VRECDCVRE19890.319937.9,199617.9200431.3VRE5


2002


76995.8%94.4%92.2%85.2%52.7%61.4%68.0%68.8%23.2%17.6%3.0%

----2000105327-329


2002~2005338

338:

  • 91.1%, 90.2%,

  • 78.4%, 66.3%,

  • 63.6%, 61.5%,

  • 48.2%, 30.5%,

  • 24.8%, 3.5%


VRE

VREVRE376VRE42


1993~2001%

2003284246~248

12VREF11

VRE70%


CDC

CDC reports first case of vancomycin resistant Staphylococcus aureusScott Gottlieb

(CDC)2002(VRSA)CDC


1997(VISA)200268VISA

2(VRSA)CDC

()BMJ 20033267382004271


4PRSP

(PRSP)(R%+I%)3.3%(1/30)+23.3%(7/30),26.6%(8/30)


1

2

3

4 PBP-2a


MRSA

MRSAPBP(PBP2a)78kDaPBPsPBPsPBP2a PBPs


mec()PBP2amecAmecA mecA(MRSA)


58.96 77.03 69.81

66.31 68.12 66.88

72.54 67.76 70.97 69.6

68.8


5

20032003-12-19


2817 2003.12.23

MRSAMRSA


MRSA

2008339


MRS

MRS ,

,MRSA


MRSA

1

Kim

Hanaki(affinitytrapping)Cui(clogging )


2

HanakiDD


3

VISAMRSA4(PBP4)

VISAPBP2MRSA320


4

199720027VISAvanAvanBvanCvanDvanE

VRSAvanAVRE


5


VRE

10 VanAVanBVanCVanDVanEVanAVanB

VanA(VRSA)


VanB

VanC


VRE


MRSAMRCNS MRSA MRCNS

VREVRSA


200938

1


//

B




1



30%

40%

50%

75%


MRSA

MRSA





207019802090


1980

2003

2005

------

2006


2005


MIC90 0.25mg/L MIC90 16mg/L

1.8mg/L86%


2000300093.61%


6

111123

100853)


%


n=30-


()3g Bid , 3,,

G+(


peptolides

daptomycin,2080,,,CPK



70SVREVISAVRSAVRE23SRNA2576G-T


Streptogramins

/AB(3:7)--20006631MRSA/


oritavancinV R EV R S A;

telavancin;

Dalbavancin1

vanAVREVRSADalbavancinvanBvanCV R EV R S A

ramoplaninUDP-N-D-


GlycyleyclinesminocyclineMRSAPRSPGISAVISAVREF


Aerythromycin A3-cladinosecar-bonyl grouptelithromycinHMR3647RU66647CP 606786ABT 773ABPISP PRSP

Ketolides


penems

faropenemPISP PRSPfaropenem daloxate1.2gbid8d1h


trovafloxacinmoxifloxacingemifloxacinMRSMRS

(sitafloxacin)MRS


(1)isepamicinarbekacinamikacinnetilmicin(2)fosfomycinMRS(3)rifampicinMRS(4)SMZ-TMP



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