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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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5200770


5200770


5200770

!


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1982199240%89%199213000199596%1998603702050500050

30%8

..

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


5200770

MRSA

20071016(MRSA)95000MRSA


5200770

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

MRSA, 18000, 2005(AIDS)16000


5200770

1004001.2245102


5200770

1998

1998WHA,

2005WHA

2002

21


5200770


5200770

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


5200770

selective pressure

1300(400)150


5200770

811


5200770

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

8133NDM-150


5200770


5200770

!


5200770


5200770

MRSAVRE1inezo1id

!

!


5200770


5200770

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


5200770

2003


2007 chinet

2007 CHINET


2008 chinet

2008 CHINET


5200770

20809010


5200770

2002


1995 2001

1995~2001,,, ()

2005156


1991 2000

1991~2000

20027258214


1992 2000

73.8%

79.9%

87.6%

1992 -2000


2002 2006 3455

2002 ~2006 3455

2006 17 10


1996 2004

1996-2004

2005926(9)


2001 2006 458

2001-2006 458


5200770

2164

200434345347334


5200770

2004


5200770


5200770


5200770

2002

2004 1 27 1


5200770

2002

2004 1 27 1


5200770

2007CHINET


5200770

2008CHINET


5200770

2008CHINET


5200770

2008CHINET


5200770

2008CHINET


5200770

2008


5200770

2008


5200770

2008


5200770

2008


2005 2007

2005 2007

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


5200770

2001-2006 458


2006 2007

20062007


2002 2004 736

20022004 736

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


5200770


5200770

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


5200770

2003 3 10 83 5


5200770

()

Chin J Nosocomio1 Vo115 No6 2005


5200770

MRS)

2080MRS)90MRS


5200770

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


5200770

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


5200770

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


5200770

Frazee11975MRSA


5200770

CDCCHageman MHSMRSA1715MRSA6521

Hageman91715(88)MRSA206


5200770

CA-MRSA


5200770

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


5200770

MRSA

MRSE

MRCNS

PRSP

VRE


1 mrsa

1MRSA

1959G

1961JevensMRSAMRSA2080MRSA

90MRSAMRSA80


5200770

MRSA190MRSA

19771979MRSA51985198624 199050199360 199864 200765.1

MRSA8090


Mrsa 2 mrsa

MRSA2MRSA

60MRSAMRSAMethicillinMRSA60-80%


5200770

MRSA28

2003310835


5200770

MRSA3MRSA

  • 1999~2000MRSA

    59.2%161/272

    39.9%105/263

    ----2002183185-187


5200770

2004, ,

MRSAMRCNS63.9%82.9%VISA,VRSAVRE

200583054


5200770

  • 19936~19947MRSA77.9%80.6%HAI

    ----199662114~116


5200770

MRSA70.8%

---- 2003147~48

MRSA71.88%

---- 2002.12 7549~550


5200770

()

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

ChinJNosocomiolVol.15No.92005


Mrsa 4 mrsa

MRSA4MRSA

SMZ

3335


2 mrcns mrse

2MRCNSMRSE

(coagulase negative staphylococci,CNSCoNS),,


5200770

CNS,CNS32,16,,,CNS70%,


5200770

CNS

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


5200770

(CRI),,8597,CNS,


5200770

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


5200770

,CNS,CNS,,,


Mrcns mrse

MRCNSMRSE

2000MRCNS79.1%

2002(MRCNS)75.3%


5200770

MRCNSMRSE

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

38 3 ,


5200770

3VRE

1986(Vancomycin Resistant Enterococcus VRE)VREVRE1990VRE


5200770

VRECDCVRE19890.319937.9,199617.9200431.3VRE5


5200770

2002


5200770

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 2005 338

2002~2005338

338:

  • 91.1%, 90.2%,

  • 78.4%, 66.3%,

  • 63.6%, 61.5%,

  • 48.2%, 30.5%,

  • 24.8%, 3.5%


5200770

VRE

VREVRE376VRE42


5200770

1993~2001%

2003284246~248

12VREF11

VRE70%


5200770

CDC

CDC reports first case of vancomycin resistant Staphylococcus aureusScott Gottlieb

(CDC)2002(VRSA)CDC


5200770

1997(VISA)200268VISA

2(VRSA)CDC

()BMJ 20033267382004271


5200770

4PRSP

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


5200770

1

2

3

4 PBP-2a


5200770

MRSA

MRSAPBP(PBP2a)78kDaPBPsPBPsPBP2a PBPs


5200770

mec()PBP2amecAmecA mecA(MRSA)


5200770

58.96 77.03 69.81

66.31 68.12 66.88

72.54 67.76 70.97 69.6

68.8


5200770

5

20032003-12-19


5200770

2817 2003.12.23

MRSAMRSA


5200770

MRSA

2008339


5200770

MRS

MRS ,

,MRSA


5200770

MRSA

1

Kim

Hanaki(affinitytrapping)Cui(clogging )


5200770

2

HanakiDD


5200770

3

VISAMRSA4(PBP4)

VISAPBP2MRSA320


5200770

4

199720027VISAvanAvanBvanCvanDvanE

VRSAvanAVRE


5200770

5


5200770

VRE

10 VanAVanBVanCVanDVanEVanAVanB

VanA(VRSA)


5200770

VanB

VanC


5200770

VRE


5200770

MRSAMRCNS MRSA MRCNS

VREVRSA


2009 38

200938

1


5200770

//

B


5200770


5200770


5200770

1


5200770


5200770

30%

40%

50%

75%


5200770

MRSA

MRSA


5200770


5200770


5200770


5200770

207019802090


5200770

1980

2003

2005

------

2006


5200770

2005


5200770

MIC90 0.25mg/L MIC90 16mg/L

1.8mg/L86%


5200770

2000300093.61%


5200770

6

111123

100853)


5200770

%


5200770

n=30-


5200770

()3g Bid , 3,,

G+(


5200770

peptolides

daptomycin,2080,,,CPK


5200770


5200770

70SVREVISAVRSAVRE23SRNA2576G-T


5200770

Streptogramins

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


5200770

oritavancinV R EV R S A;

telavancin;

Dalbavancin1

vanAVREVRSADalbavancinvanBvanCV R EV R S A

ramoplaninUDP-N-D-


5200770

GlycyleyclinesminocyclineMRSAPRSPGISAVISAVREF


5200770

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

Ketolides


5200770

penems

faropenemPISP PRSPfaropenem daloxate1.2gbid8d1h


5200770

trovafloxacinmoxifloxacingemifloxacinMRSMRS

(sitafloxacin)MRS


5200770

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


5200770


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