Source

1

??????????????????? ??? ????? ???? ???
2
????

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

3
? ? ?
??? Source
???? Susceptible host
???? Means of transmission
4
(No Transcript)
5
?????????

• ???????,???????,?????????
• ????????????????
• ???
• ????????????

6

• ??????????
• ????????????.???????.???????????????.
• ??????????.??????????.
• ????????????????????????.
• ???????????????????????.

7
???????? SSusceptible(??.??) RResisitant
(????.??) IIntermediate (??.????) ?????? ?????? M
RSA(ORSA)? VISA/VRSA? VRE? ESBL?(Extended
Spectrum ß-lactamase) KPC? MDRAB/PDRAB?
8
ESBL(Extended Spectrum ß-lactamase)

• ???????,??????????????????(ß-lactamase)
• ??????????????????????cephalosporin????
• ???????ESBLs?????????????,????????cephalosporin,
  penicillins?aztreonam

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ESBL(Extended Spectrum ß-lactamase)

• ?????,ESBLs??????????(TEM?SHV)??????
• ???????????????TEM??SHV?ESBLs,?????ESBLs??CTX-M?IM
  P
• ????ESBLs???????????,?????????????????????,???????
  ????????

10
ESBL(Extended Spectrum ß-lactamase)

• ????????Klebsiella spp.?E.coli
• ????Enterobacter, Salmonella, Proteus,
  Citrobacter spp, Morganella morganii, Serratia
  marcescens, Shigella dysenteriae, Pseudomonas
  aeruginosa?Capnocytophaga ochracea ????

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KPEKPC

• Carbapenem-Resistant Enterobacteriaceae (CRE)
• Klebsiella Pneumoniae Carbapenemase Confers
  resistance to all b-lactams including
  extended-spectrum cephalosporins and
  carbapenems?Most commonly in Klebsiella
  pneumoniaeAlso reported in K. oxytoca,
  Citrobacter freundii, Enterobacter spp.,
  Escherichia coli, Salmonella spp., Serratia spp.,
  

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Susceptibility Profile of KPC-Producing K.
pneumoniae
Antimicrobial Interpretation Antimicrobial Interpretation
Amikacin I Chloramphenicol R
Amox/clav R Ciprofloxacin R
Ampicillin R Ertapenem R
Aztreonam R Gentamicin R
Cefazolin R Imipenem R
Cefpodoxime R Meropenem R
Cefotaxime R Pipercillin/Tazo R
Cetotetan R Tobramycin R
Cefoxitin R Trimeth/Sulfa R
Ceftazidime R Polymyxin B MIC gt4µg/ml
Ceftriaxone R Colistin MIC gt4µg/ml
Cefepime R Tigecycline S

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Carbapenemases in the U.S.
Enzyme Bacteria
KPC Enterobacteriaceae
Metallo-b-lactamase P. aeruginosa
OXA Acinetobacter spp.
SME Serratia marcesens
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MDRAB PDRAB

• MDR-Ab??????7??????????,?? ?????????penicillins?
  ?????cephalosporins??????aminolycosides?????quinol
  ones??????carbapenems?????tetracyclines????sulfana
  mides?????5??????
• PDR-Ab?????7??????????

15
???????????
??????? ??????? 1.PE (R)

1.AM 2.OX(R)
2.AN 3.VA(S) 303?
3.GM 4.CZ(R)
4. CXM 5.ER (R)

5.CTX 6.CC(R)
6.CIP
7.OFX

8. LXV
9.SXT
10.IPM
(Tienam) 840?
11.CAZ

12.CZ
16
?????????
17

• ????

18
?????Enterobacteriaceae group

• Bacteria in Enterobacteriaceae group are common
  causes of community and healthcare acquired
  infections.
• E. coli is the most common cause of outpatient
  urinary tract infections.
• (C?????????????????80.816.52.7)
• E. coli and Klebsiella species (especially K.
  pneumoniae) are important causes of healthcare
  associated infections.
• Together they accounted for 15 of all HAIs
  reported to NHSN in 2007.

19

• ????(Escherichia coli)
• ???????,??? ???.
• ??????,?????????????.
• ????????????,????? ????????.
• ??????ESBLs ??,?????????????????.

20

• ????????
• (Klesiells pneumoniae)
• ????????,????????,???????.?????????????.
• ??? BSI.UTI,??????.?????.
• ?????????????????????.??ESBLs,KPC

21

• ????(Proteus spp.)
• ???????????????,???????,?????????????.
• Proteus mirabilis(??????)???????.
• Proteus vulgaris(??????)????????????.
• ??????????????,???????????.

22

• ?????(Serratia marcescens)
• ????????,????????,
• ??????????.
• ????????????.??????.???????????????.
• ??????,??????????????.
• ???ICU?UTI.BSI????,????.

23

• ?????(Salmonella spp.)
• ???????,????.??????????,???????????.
• ?????????????????????.??????.??.???????.?????????
  ????.
• ??????????????????????,?????????.

24

• ???(Enterobacter spp.)
• E. aerogenes ? E. cloacae.???????????????????????
  ????????????????.
• ????5???????????,?????????.
• ???????????????.

25

• ???(Enterococcus spp.)
• ????????????,? D?????,????????????
• ??????????????,????Pencilinaminoglycoside (GM,
  AN, SM, KM) ????????,??????????,?????Vancomycin?
• Vancomycin Resistance enterococcus (VRE)
  ?????????.

26
????

• ????(Acinetobacter baumannii)
• ?????? (Burkholderia cepacia)
• ???? (Pseudomonas aeruginsa)

27

• ????(Acinetobacter baumannii)
• ???(GNF-GNB),?????????, ?????????????????????????
  ?13?.
• ??????????????????????.
• ?????????????,???????????????.
• ???????????????.

28

• ?????? (Burkholderia cepacia)
• ???(GNF-GNB),????????.
• ??????????,???????????????.
• ?????????????.
• ??????BSI.UTI.SSI.RTI.??.

29

• ???? (Pseudomonas aeruginsa)
• ??????????????.
• ????????????????,????.
• ???????????,????????????.??.
• ?????????.

30

• ???????(Legionella pneumophila)
• ???.???.???????
• ??????????????????.???.????????????????
• ??????????????????????
• ????Erythromycin?Rifampin

31
?????

• Corynebacterium spp.
• Lactobacillus spp.
• Bacillus spp.
• Propionebacterium spp.
• Most streptococci(non-haemolytic streptococci)
• CNS
• Micrococcus spp.
• Staphylococcus aureus
• Enterobacteriaceae
• Acinetobacter baumannii
• Fungi

32

• ??????? (Staphylococcus aureus)
• ????????????.
• ?????????????,?? ?BSI.SSI.RTI??.
• ORSA(Oxacillin-Resistance S. aureus or
  MRSA),??????????,?? ???.

33

• ?????? ??Staphylococcus epidermidis,
• Coagulase negative Staphylococcus(CNS)
• ????????????
• ?????????????
• ???????????????,????,???????,???Vancomycin????????
  ?????.
• ????????????????????

34
??????
35

• ?????(Streptococcus pneumoniae)
• ?????????????.??????????.
• ????????,??????????????????.???.????,????????,????
  ???.
• Penicillin G??????????????,???.

36
???? (M. tuberculosis) ?????,????????????????. 1.?
?????(Mycobcteium tuberculosis)
??????????. 2.??????(M.leprae) 3.?????????????????
????. 4.MOTT
37

• MOTT(???????) Mycobcteium other than
  tuberculosis
• ?????????M.kansasii, M. sacrofulaceum , MAC.,
  M. xenopi, M. fortuitum, M. chelonei ss.
  abscessus
• ??????,?????????,?????????????,????????????

38
?????????

• Candida albicans
• Candida glabrata
• ???????????
• ?????Mycolpasma pneumonia?????
• ??
• ??

39

• ????????

40
A??97??????????

• ??????31.2(????15)
• ??????????28.3(402/1420)
• CNS313(22.0)
• Corynebacterium spp.50(3.5)
• Viridans Streptococcus23
• Micrococcus spp.5
• Bacillus spp. GPB7
• Propionebacterium spp.4

41
??????

• ??????? 31.2,?????????1416
• ????28.3???????????????
• CNS???????22.0,??CNS????????,?????????,??????????
  ?,????????????????Antibiogram?CNS?
• ?????????????????

42
CNS???????????
?????? ?????() ?????() ?????()
(??/???) ??? ??? ??
1/1 0 97.1 2.9
1/2 2.6 94.8 3.0
2/2 60 3.3 36.7
1/3 0 100 0
2/3 75 0 25
3/3 100 0 0
Clin Infect Dis,1997
43
??

• ???(pathogens)
• CNS
• Staphylococcus aureus
• Strepto. pneumoniae
• Enterococcus
• Enterobacteriaceae
• Pseudomonas
• Haemophilus influenzae

• ??? (Contaminant)
• CNS
• Most streptococci
• Diphthreroid
• Lactobacilli
• Propionebacterium spp.
• Enterobacteriaceae

44
????????
?????? ?????
??(?????) ??
? CSF
? ???
??? ???
????? ???
??? ?????
??
45
?????????????

• ??1???????,??????
• ??2????????????
• ??
• 1.70??
• 2.??2??
• 3. ?70??(????)
• ?????????????

46
???????-CLSI

• Blood culture tube???????
• Coagulation tube(???)
• Plain tube
• Additive tubes
• - Gel separator tube
• - Heparin(????)
• - EDTA (CBC?)
• -NaF(???)

47
??????????????(???)

• ????,???,Luer adapter
• HOLDER

48
?????????????

• ????? Luer Adapter
  ???????????? ??IV????
  

49
A??97??????????

• ?????????????(50.1,295/589)?
• ??????88.3 (1040/1297)
• ???????????????1/10 (11.3)

50
?????????????????????

• ?????????????????
• ?????????????????
• ???????????????????????????????????
• ???????????
• ??????

51
A??97??????????

• ??????59.5 (66/111)
• ??????15.3(17/111)
• ?????? 25.2(28/111)
• ??28???????????18?,??????16.2(18/111)
• ??Coagulase negative Staphylococcus?Corynebacteri
  um sp.?Viridans Streptococcus

52
????????????????????

• ????????????????
• ?????????????????
• ???????????????????????????????????
• ???????????????????????
• ??????

53
A??97??????????????????

• ???????????????(79.2)
• ?E. coli?K. pneumoniae?Proteus mirabilis??????(?ES
  BL strain)?????30.0?15.1?11.7,?????????????,????
  ???Enteococcus sp. ,?????????,??????????64.4
• AB??????????,?????,????????(6.1)????(3.6)
• CNS?????,????????????,?????????

54
A??97??????????????????

• E.coli? ESBL???7.1(36/133)
• K.pneumoniae?ESBL???15.4(8/52)
• P. mirabilis?ESBL???1.5(1/67)
• ???????,????
• ORSA???S. aureus????77.8(7/9)
• ???????,????????,????
• AB??????????,Imipenem??????50
• ???RCW?????,???????

55
B??97??????????????????

• E. coli (ESBL)28.3 (174/615)
• K. pneumoniae (ESBL) 55.1 (157/285)
• Proteus mirabilis (ESBL)3.0 (15/396)
• ORSA92.2 (119/129)
• ?Carbapenem?IPM?MEM?????K. pneumoniae
  (ESBL)??99?95?K. pneumoniae??95?76,??????KPC??
  ??
• AB??????,????

56

• ??????????????ESBL?MRSA??(2007.07 2008.06)

57
B???????

• ?Carbapenem?IPM?MEM?????K. pneumoniae
  (ESBL)??99?95?K. pneumoniae??95?76,
• KPC???????

58
??

• ??????????????????,??????????,??????
• ????,?????????????????
• ?????????????????,????,??????????????????
• ???????????????
• ???????????,????????

59
????                                    
                               
???? ????