?G ???????????

1
?G???????????
? ?
2
???? ??G????????? ??G?????????
???G???????????
3
??G?????????
4
?????G???? ??????????????????????
????????????????????
5

• ??????????
• ?????????????(MRSA)70??
• ??????????????(MRCNS)80,
• ?????
• ???????????????90??,????
• ???????????60????
• ????ß????????????????50
• ???????????2030
• ??????????????????
• ?????????
• ????????????

6
? ?????????????
2007??? CHINET??????????????????
7
2008??? CHINET??????????????????
8
???????
??????????? (??9??13?????)
????????????????!!
9
(?)????????????????
????????????20??8090??????????????,?10???????
?????????????,????????????????,???????????????,???
???????????????????
10
???????2164???? ????????
?? G-?? G?? ???? ??
1999 45(57.69) 25(32.05) 8(10.26) 78(6.56)
2000 42(52.50) 24(30.00) 14(17.50) 80(6.73)
2001 60(48.00) 56(44.80) 9(7.20) 125(10.51)
2002 112(30.94) 217(59.94) 33(9.12) 362(30.45)
2003 169(31.07) 326(59.93) 49(9.00) 544(45.75)
?? 428(36.00) 648(54.50) 113(9.5) 1189(100.00)
????????,2004,3(4)345347?334
11
1996-2004?????????????????????????
????2005?9??26?(?9?)
12
2002 ?2006 ?????????????3455??????????
????2006 ??17 ??10 ?
13
2001-2006 ???????????458 ?????????????
14
????????????????
?????????2008??30??3?316-317
15
??????2009??10??1?97-99
16
(?)G????????
?????????????
? ?????????????(MRSA) ? ????????????(MRSE) ?
???????????????(MRCNS) ? ??????????(PRSP) ?
?????????(VRE)
17
2005-2008 ???CHINET??????? ????????? 2005-2008 ???CHINET??????? ????????? 2005-2008 ???CHINET??????? ????????? 2005-2008 ???CHINET??????? ?????????
?? MRSA() MRCNS() ??PISPPRSP()
2005 69.0 82.0 61.0
2006 58.4 76.3 88.2
2007 58.0 77.0 88.5
2008 62.3 77.0 90.4
18
2006??2007???????????????????????????????????
19
?????????????(MRSA)
90??????,MRSA??????????,?????????????????
?????,MRSA?????80???
20
???????????????????
??? 1988 1989(244?) R 1990 1994(563?) R 1995 1999(1450?) R 2000 2003(1879?) R
??? 94.9 90.5 95 96.6
???? 0 8 55.7 66.9
???? 0 5.3 48.6 61.6
???? 16.8 15.8 56.1 68.8
???? 0 13.9 54.7 67.8
??? 61.5 59.7 79 83.1
???? 0 0 0 0
??????????????
??????? ?????????????? ??? ???
21
MRSA??190????MRSA???????????????????????
????1977?1979?MRSA????5,1985?1986??24
,1990?????????50,?1993?????60 ,1998??64
,2007??65.1? ???,MRSA?????????????8090?
22
MRSA??2MRSA???????
??60??????????????(MRSA)??,?????MRSA??????????
?(Methicillin)??????,MRSA?????????,???????????????
??????????????????????????60-80???
23
MRSA?28??????????()
??? ?? ?? ???????????????????2003?3?10??83??5?
24
MRSA??3MRSA????????????????????????

• ??????????????19992000???????????????????MRSA???
  
• ????59.2(161/272),
• ????39.9(105/263)?
• ----(????,?????????2002,18(3)185-187)

25
MRSA ???
???? 61.9 ???? 73.7
???? 84.4 ???? 68.8 ???? 13.8 ???? 23.7

?????54
?????? 58.5
????? 63.2
????? 63
2007??CHINET
26
???????????????????????(MRCNS?MRSE)
??????????(coagulase negative
staphylococci,CNS?CoNS)????????,?????????,????????
?,????????????????????????,????????????,????????,?
??????????,?????????????
27
CNS???????????????????????,??????CNS?32?,??
16??????????,????????????,???????,????????????????
,????CNS?70??,?????????????????
28
??????????????????????(MRCNS?MRSE)??????
???????????? MRCNS??????????,????869?MRCNS
?75(652/869)????3????????,???????????,???????????
??????????????????????????????????89.1?19.2?29.6
?46.9?56.3?64.5?86.3?100"
????????? ?38? ?3 ? ???,?
??????????????????????
29
(No Transcript)
30
CNS????? ????? ???????????,?????????????????
???,???20??80???????,CNS???????,???????????????,??
???????????????CNS?????????,??????????,?????,?????
???????????,?????????,??????????,????????
31
???????(CRI) ??????????????????????????????????
??,???????????????????????????????????????????????
??????????????,??85???????????????97??????????,???
???CNS??????????,??????????????
32
?????? ????????????,?????,????428????????????
???,??248?(57.94)?????,??????????????????,??CNS??
?????1880??????????304???,????CNS??,?40.8,??CNS??
????????????????
33
????? ??????????????????????????,???CNS??????
??????????????????????????????????,??????CNS?????,
???????,?????????????????,????????
34
??????????(VRE)
???VRE???????,???????????,???CDC?????????????,
VRE??????1989??0.3???1993??7.9,?1996??17.9???20
04??31.3???VRE??????5?
35
2008???CHINET???????
36
2008????????????
37
2002?2005?????????????338??????????
338??????????????? ???91.1,
???90.2, ????78.4, ???66.3,
????63.6, ????61.5, ????48.2,
???30.5, ????24.8, ????3.5
38
?????????????????????(??????????)
????????????(MRSA)????29.9??????????????
(MRCNS)????31.3,MRSA?MRCNS????????
ChinJNosocomiolVol.15No.92005
39
(?)??????????(MRS)???????????
?20??80????,??????????(MRS)??????????????,90??
??MRS??????????????????????????????????????????
40
??????????????????????????? ?,?
?,???,???,???(???????????)
Chin J Nosocomio1 Vo1.15 No.6 2005
41
???????????? ???????????
??CDC???????C.Hageman MHS??,MRSA??????????????
???????????,???????????????????????17????,15??MRSA
????????????????????65??????????????????21?,??????
???????????? Hageman???????????9???1
7?????????????,??????15?(88)??MRSA??????????20.6?
?
42
??G?????????
43
??????????????????
??????
???(????)
????? ?????? ????? (??)
44
??????
???
??!
45
  ???????
1 ???????????? 2 ?????????????????? ??? 3
???????????????????????? 4
????????,????????????????(PBP-2a)???????
46
?1 ??4????????
47
MRSA?ß- ????????????
?MRSA????????PBP(PBP2
a),???????????78kDa????????,??ß-?????????????,????
?????PBPs??????????????????????????PBPs???,PBP2a
???PBPs???,??????????,???????,???????
48
????????????mec(??????????)??,????PBP2a????
??mecA?????????????mecA ??????????????????????,???
????????????????,??mecA?????????????????????????(M
RSA)?????

49
(No Transcript)
50
(No Transcript)
51
2001?????ß-???????????????????() ??
58.96??? 77.03??? 69.81? ?? 66.31??? 68.12????
66.88? ?? 72.54??? 67.76??? 70.97???
69.6 ??????68.8 ???????
52
??????5????????????
1998??? 1999??? 2000??? 2001??? 2002???
???? 180 168 145 124 99
????? 69 13 4 3 1
???? 34 40 27 19 19
?????/???? 17 12 9 5 5
???? 24 29 39 17 12
????/???? 28 27 29 26 16
???? 9 7 7 6 6
???? 19 372 305 23 17
2003??????????????????? 2003-12-19
53
????20042007????? ???????????
??? 2004? ?? 2005? ?? 2006? ?? 2007? ??
???? 52 54 62 68
???? 67 65 50 50
??? 183 119 124 115
???? 3 2 1 1
???? 26 21 26 26
???? 50 35 27 27
???? 13 13 15 19
???? 69 70 81 64
???? 4 3 6 17
???? 5 4 5 8
?????MRSA,VRE???
2007???????????????? 2007-12-19
54
???????????,? ????? ??? ??!
55
?????2011?4?7?

• ??????????????,??????????,????????????????????????
  ???????
• ?2011???????,??????????????????,????????????

56
???G???????????
57
?????,????
???????????? ?????????????????,?????????
??,????MRSA??????????,????????????????,???????????
??????MRSA ???????? ??????????????? ??????????????
??
58

• ?????????????????????????????(????201128?)
• ??????????????

59
????????(?????201156?)
??????????????????????? (2011?4?18?) ????

1. ???????????????
2. ????????????????
3. ??????????????????
4. ??????????????
5. ??????????

60
????????????(?????84?)?????????? 
2012-05-08   ??????????????2012?2?13?????????
???,?????,?2012?8?1????? ??
? ? ???????????
61
???MRSA???
MRSA?????????????????????,??????????????MRSA??
?????????????,?????????(??????),??????????????????
?????????????????????????,????????????????????????
????????????MRSA?????,????????????????
62
???????????? MRSA????????
??????2008?3??3??9?
63
?????????????????????????????,??????????2817?
??????????????????????????,??????????????????????,
???????????????????? ??????,????????????????????
??????????????????,??,????????????????????????????
,???????????????????????????,????????????????,????
???????????????????????????,?????????????????????

???????????????? 2003.12.23
????????????????MRSA???????!????????????,??MRSA???
????!
64
?????????

• ?????,MRSA ?????????,????,?????????????,
  ?????????????????????
• ??????????????????????????,?????????????????
  ?????????????????????????MRSA?????????????????????
  ?,??????????????,??????????????????????????

65
MRSA????????,?????????????!
??????????????? ???? ?????????(MRSA)??
????????????? ?????,???,SMZ
??????????????, ????!
???????????????3335?
66
????????????????
?????????????????(??)???????????????
??????????????????????
67
???????????????
?????????????????(??)??? ???????????? ?????????
??????????????????????.2006,26(6)473475
68
??MRSA????????????!
?????? ?????(Quinupristin/Dalfopritin)????-???
?,1999?????? ????? ????(Linezolid)??????,2000?
?????
69
???G?????????
???????????gt70???????
??????? ?????? ß-??????
1 ???? ???? ????
2 ??? ???? ????
3 ???? ??? ???
4 ????????? ???? ???
5 ???? ???? ????
6 ???? ???? ????
7 ???? ???? ????
8 ???? ???? ????
9 ????
70
???G?????????
??????????gt70???????
???? ????
1 ???G ???
2 ???? ????
3 ???? ????
4 ???? ????
5 ???? ????
6 ????
7 ????
71
???G?????????
??????????gt70???????
????? ????? ?????
1 ???? ???? ???G
2 ???? ???? ????
3 ???? ???? ????
4 ???? ???? ????
5 ???? ??? ????
6 ???? ???? ????
7 ??? ???? ????
8 ????? ???
9 ???? ?????
10 ??? ????
11 ???? ????
12 ????
72
?G?????????
????(Cefathiamidine, CTM), ????(Cefazolin,
CEZ), ????(Cefuroxine, CXM) ,
????(Ceftriaxone, CRO) , ????(Oxdcillin, MPIPC),
????(Vancomycin, VCM),
??,???????2003?4??28??4?
73
???G?????????
????????????MRS??????????
????????6?????????????????????, ??
?????2003,28(4)221-223 ?
74
???G?????????
?????6???????????????????
??1 ??1 ??1 ??1 ???2 ??3 ( ?????????????,??10085
3)
75
???G?????????
?????????????????????????()
76
???G?????????
??????????????????????(n30)??-???????
77
????MRSA
????
????????????????????
?AvsB P?0.05,BvsC Pgt0.05
???(???????????)???????2010,35(6)469-471?
78
??????????
?AvsB P?0.05 ? AvsC P?0.01
???(???????????)???????2010,35(6)469-471?
79
????????????
????(ceftobiprole)???????????????,???MRSA?
??G??G-??????????????????????2a????????,??MRSA?MI
C??????????????????????????????MRSA?MIC??0.1252mg
/L,??????????S4mg/L?Denis?????? (VISA)??????
?????????MRSA?VRSA????????????,???????????????????
????????????????????
80
????????????
????????????????????????????????G????????
??????,????????????????????????????????(??MRSA????
)?????????????????,??MRSA,?????(MDRSP),?????????(P
RSP),?????????(VISA),?????????(VRE)???????????G-??
??????????????????????????,??????????????
81
?G????????
????(daptomycin)?????????????????,???20??80????
,????????????,???????????????,????????????,???????
????,?????????????????????????????????????????????
????????????????????????(CPK)???
82
?G?????????
????????70S????????????????,??????????????,??
??????????????,??????VRE?VISA?VRSA???????????????,
???????VRE????,????????23SRNA?2576???G-T??,???????
???????
83
?G??????????
????/??????????A??????????B????????(37),??????
?,?????????????,????????,????????????????????-????
-???????????????????????,????????????2000?????????
?,???66???????????31MRSA?????/????????
84
?G??????????
????(oritavancin)?????????????,?????????
?????,??????,????????????,???V R E?V R S A????
????(telavancin)????????,????????????
Dalbavancin????????,????,????1??
?????????,?vanA?VRE?VRSA??,Dalbavancin?vanB?vanC?V
R E??,?V R S A????? ????(ramoplanin)???????
???,????????,????????????????,????????????,??UDP-N
???-D-??????????
85
?G?????????
??????????,?????????????(minocycline)???????????
??????????????????????????????????????,???????????
????MRSA?PRSP??????,???????????????(GISA?VISA)????
?????????(VREF)?
86
?G????????
??????????????,????????A(erythromycin
A)?3-????(cladinose)?????(car-bonyl
group)???,?????????????????????????????,?telithrom
ycin(HMR3647,RU66647CP 606786)?ABT
773??????????????????,????????????????????????????
??????A??B??????????????????????,?????????????,???
????????(PISP ?PRSP)????????????,?????????????????
???
87
???????faropenem????????????????????,????
??,??PISP ?PRSP????????,???????????,??????????????
??,??????????????????????(faropenem
daloxate)???????????????(?????1.2gbid8d)?????,???
???1h?
?G?????????
88
?G??????????
????(trovafloxacin)?????(moxifloxacin)?????(ge
mifloxacin)?????????????????,??????????????MRS???,
??MRS????????????????????? ????(sitafloxacin)?
?????????????????????,??MRS?????????
89
????
?????????????????????,??????????????????????????
,??????????? (1)?????????(isepamicin)?????(arbe
kacin)?????(amikacin)?????(netilmicin)?
(2)???(fosfomycin)?????????????????MRS???
(3)???(rifampicin)??????????????MRS???
(4)SMZ-TMP?
90
The One That Fits Is The Best! ?????? ??????!
91
??!