中国细菌耐药性现状（英文版）精选.pptVIP

Bacterial Resistance in China  Minggui Wang, M.D. Institute of Antibiotics Huashan Hospital, Fudan University Outline Antimicrobial Resistance and It’s Mechanisms Gram-positive cocci Streptococcus pneumoniae Staphylococcus spp. Gram-negative bacilli Enterobacteriaceae Escherichia coli Klebsiella spp. Enterobacter spp., et al. Non-fermenting gram-negative bacilli (non-fermenters) Antimicrobial Resistance in Streptococcus pneumoniae Penicillin resistance in S. pneumoniae in China in late 1990’ Penicillin resistance in S. pneumoniae in China in early 2000’ Increasing trends of Penicillin resistance in S. pneumoniae in China Reasons causing the rapid increasing of penicillin resistance The increasing consumption of oral penicillins such as amoxicillin The spead of resistant colonines Difference of penicillin resistance in S. pneumoniae isolated between adults and children Resistance of S. pneumoniae to macrolides 70%-90% of S. pneumoniae clinical isolates were resistant to erythromycin Mechanism of bacterial resistance:Mosaic PBP Genes in PRSP Penicillin resistance is due to alterations in endogenous PBPs DNA from related streptococci taken up and incorporated into S. pneumoniae genes Mechanisms of resistance to macrolides(Wang M. Diagn Microbial Infect Dis 2001; 39:187) Target modification Phenotype cMLS, 90% (159/176) Phenotype iMLS, 6% (10/176) Active efflux Phenotype M 4% (7/176) Antimicrobial Resistance in Staphylococcus spp. Trends of methicillin resistant Staphylococcus spp. (MRS) in China Mechanism of MRSA MRSA contain novel PBP2a, substitutes for native PBPs; low affinity for all ?-lactams PBP2a is encoded by mecA gene; expression controlled by mecI, mecR1 and other factors SummaryAntimicrobial resistance in gram-positive cocci Penicillin resistance in S. pneumoniae has been increasing markedly since 2000 in China The resistance rates of S. pneumoniae to macrolides such as erythromycin are very high Methicillin-resistant staphylo