第一节 临床常用抗菌药物 第二节 抗菌药物体外敏感性试验 第三节...
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Transcript of 第一节 临床常用抗菌药物 第二节 抗菌药物体外敏感性试验 第三节...
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1929Flemin1940ChainFlorey
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1932Domagk1942Waksman
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1959Chain6APA1973-
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.NCCLSK-BE
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-iodometric testnitrocefin test
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NCCLS ()
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The endThank you
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-1. 2. 3. 4.5. 6.-/-
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Metronidazole Tinidazole ornidazole
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PCR PCR-RFLPPCR-SSCP PCR- DNA
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1.- - 2. 3(AAC)(APH)(AAD)3. 4.
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OmpF OmpC PhoE OprK
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1. 2. 3. DNA
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4. -5. PBP , -PBPPBP2aPBP3 6.van
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- (Ambler) ( Bush)-Lam C 1 AmpC A 2a PC1 2b TEM-12 SHV-1 2be ESBLs TEM-329, SHV-26 2br (IRTs) TEM30-41,TRC-1 2c PSE-1 CARB-3 2e Cxase 2f IMI-1,NMC-ASme-1 D 2d OXA-1,PSE-2 4 Zinc-Lam B 3 L1
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AST
AST
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AST S R SFS
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ASTRRRSSS
AST ART
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AST 1 1.SIR 2.MIC 3.E testMIC2 VitekMicroscan Phoenix3 PCRmecA4 NitrocefinESBL
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AST R I S MIC-time above MIC %=MIC90h /htimeMIC=40~50% good 60~70% very good1
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- 123 PAE MIC
PAE
4 PAE
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AST ()() () ()MRS, PRP, VRE, ESBL
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AST WHONET
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AST ASTART Medical choice Bacteriological choice
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MH,MICMBCMIC
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()
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MICMIC
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E Epsilometer testE5mm50mmg/ml15-20
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E
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MIC16mg/L
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DNA
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1 D-
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2D-Ala-D-Ala -
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--
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pBp
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1 GV methacillin oxacillin cloxacillin
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2G(ampcillin)(amoxicillin) - ,(carbenicillin)(ticarcillin)
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2 , (mezlocillin)(azlocillin)(piperacillin) +- - -ampicillin-sulbactam(unasyn);-()ticacillin-lavulanate(Timentin);-()amoxicillin-clavulanate(Augmentin);- piperacillin-tazobactam
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(cephalosporins)7- - ,
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,PBP,PBP,,
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- -,3--,,PBP3,,, ,(aztreonam,) -
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1. (cephamycins) 2,(cefoxitin)(cefotetan) (cefmetazole) -,,
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2. (moxalactam) ,,,-,
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- -,MRS(impenem)(meropenem)(biapenem)(panipenem)
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21,
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30S
mRNA ,
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(quinolones) 6,7 DNA(II)DNA,DNA
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14~16,,5,3
50S23S,,
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67,, 30S,RNARNA,,
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70S50S,
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50S,,, lincomycinclindamycin,
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D DD-D
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, MRSBE
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,,F() SMZ/TMPSD/TMP
(sulfamethoxazoleSMZ),(sulfadiazine,SD)(sulfamethoxypyrazine,SMPZ)
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isoniazid,INHrifampin,RMPpyrazinamide,PZAethambutol,EMBstreptomycin,SMparaaminosalicyclic acid,PASethinamade,TH1314cycloserin,CScapreomycin,CPMkananycin,KMrifabutin
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ADC AC BC A