12
1929Flemin1940ChainFlorey
.
1932Domagk1942Waksman
1959Chain6APA1973-
.NCCLSK-BE
-iodometric testnitrocefin test
NCCLS ()
The endThank you
-1. 2. 3. 4.5. 6.-/-
Metronidazole Tinidazole ornidazole
PCR PCR-RFLPPCR-SSCP PCR- DNA
1.- - 2. 3(AAC)(APH)(AAD)3. 4.
OmpF OmpC PhoE OprK
1. 2. 3. DNA
4. -5. PBP , -PBPPBP2aPBP3 6.van
- (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
AST
AST
AST S R SFS
ASTRRRSSS
AST ART
AST 1 1.SIR 2.MIC 3.E testMIC2 VitekMicroscan Phoenix3 PCRmecA4 NitrocefinESBL
AST R I S MIC-time above MIC %=MIC90h /htimeMIC=40~50% good 60~70% very good1
- 123 PAE MIC
PAE
4 PAE
AST ()() () ()MRS, PRP, VRE, ESBL
AST WHONET
AST ASTART Medical choice Bacteriological choice
MH,MICMBCMIC
()
MICMIC
E Epsilometer testE5mm50mmg/ml15-20
E
MIC16mg/L
DNA
-
1 D-
2D-Ala-D-Ala -
--
pBp
1 GV methacillin oxacillin cloxacillin
2G(ampcillin)(amoxicillin) - ,(carbenicillin)(ticarcillin)
2 , (mezlocillin)(azlocillin)(piperacillin) +- - -ampicillin-sulbactam(unasyn);-()ticacillin-lavulanate(Timentin);-()amoxicillin-clavulanate(Augmentin);- piperacillin-tazobactam
(cephalosporins)7- - ,
,PBP,PBP,,
- -,3--,,PBP3,,, ,(aztreonam,) -
-
1. (cephamycins) 2,(cefoxitin)(cefotetan) (cefmetazole) -,,
-
2. (moxalactam) ,,,-,
- -,MRS(impenem)(meropenem)(biapenem)(panipenem)
-
---
21,
30S
mRNA ,
(quinolones) 6,7 DNA(II)DNA,DNA
14~16,,5,3
50S23S,,
67,, 30S,RNARNA,,
70S50S,
50S,,, lincomycinclindamycin,
D DD-D
, MRSBE
,,F() SMZ/TMPSD/TMP
(sulfamethoxazoleSMZ),(sulfadiazine,SD)(sulfamethoxypyrazine,SMPZ)
isoniazid,INHrifampin,RMPpyrazinamide,PZAethambutol,EMBstreptomycin,SMparaaminosalicyclic acid,PASethinamade,TH1314cycloserin,CScapreomycin,CPMkananycin,KMrifabutin
ADC AC BC A