ESBL s. BL s, ESBL s,

Transcription

1 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No ( extended2spectrum 2lactamases, ESBL s) 2, [ 1 ], (), ESBL s : 2 2, : 2, 2, 34, 2, 2ESBL s ESBL s AmblerA D, Bush2be, ESBL stem SHV CTX2M OXA ESBL s, PER VEB CMZ TLA SFO GES 2 ESBL s 1982 ESBL s, ESBL s ESBL s, [ 224 ], ESBL s ESBL s ES2 BL s, ESBL s, 50% ESBL s, ESBL s, 40%, ESBL s, 60%, [ 527 ] ESBL s,, DO I: /cma. j. issn

2 208 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No. 2, ( 7 d) ( ) 60ESBL s 12 Bush Ambler 2 1 C AmpC 2 A D 2a A,, 2, 2b A 2, TEM21 SHV21 2be A 2 ( ESBL s) 2 2br A 2c A 2 SHV, TEM ( IRT) 2d D ( ) 2e A 2f A 3 3a 3b 3c B 2 4 ESBL s ( ),, ESBL s, ESBL s [ 8210 ] SHV22 SHV25 ; TEM 23 ; TEM 210 TEM 212 TEM 226; CTX2M ESBL s ; TEM SHV ESBL s CTX2M,, ESBL s CTX2M, SHV, TEM,, [ 4, 11 ] ESBL s,, ESBL s, ESBL s,, ESBL s,,, ESBL s, ESBL s 1. :, 2,

3 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No ESBL s,, ES2 BL s, 2. : ESBL s, :, 2, 5 mm, ESBL s ;, M IC M IC 3, ESBL s,, E2test [ 12 ] 3. ESBL s : ( 1) : ES2 BL s, (p I),, ESBL s ESBL s,,, ( 2):,,,,, 4. ESBL s : (1) ( PCR) : DNA,,,, ESBL s DNA2DNA PCR ( PCR2RFLP), ESBL s (2): ( PCR ), ESBL s, ES2 BL s ESBL s,,esbl s ESBL s ( ) ESBL s [ ] 1. ESBL s, EBSL s 2. ESBL s,

4 210 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No. 2 : (1) ; (2) ; (3) ; ( 4) ; (5) 3. ESBL s,,, 4., ESBL s, (3 4) d,, 2010(CLSI)M1002S20,,, ( )ESBL s [ ] 1. :ESBL s,,, ESBL s, /, ESBL s, ESBL s 2. 2 / 2: ESBL s 2 ESBL s, 2 / ESBL s, ESBL s, 2 / 2, / /, 2, 2 / 2 3. :,ESBL s, ESBL s,, (AmpC ), 4. : ESBL s

5 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No , ESBL s, ESBL s ESBL s, ESBL s,,, ESBL s 5. : ESBL s ESBL s ( ), ESBL s, ESBL s, ( Tigecycline) EBSL s, ESBL s 93. 8%, ( ) ESBL s [ ] 1. : ESBL s,, ESBL s ESBL s 2010 CLSIM1002S20, ESBL s ( ),,, 2 / 2( / // / ) ( ),( ) ESBL s,esbl s, 2. : ESBL s, 2 / 2 ( / / ) ( ), ( ),, ESBL s 3. : ESBL s,( ), / / /,,,, ESBL s

6 212 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No. 2 ESBL s ESBL s,, ESBL s,, ESBL s 1. : ESBL s,esbl s [ 23 ] ESBL s, ESBL s CLSI (),, ( PFGE) ESBL s, ESBL s ESBL s, 2. :, ESBL s, [ ] ESBL s, ESBL s ESBL s,, N ICU ESBL s, ESBL s 3. : EBSL s,,,, ;, ESBL s,esbl s ESBL s ESBL s, ESBL s ESBL s ( ) ( ) ESBL s, ESBL s, ESBL s ( ) :

7 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No : 1 Song KH, Jeon JH, Park WB, et al. Clinical outcomes of spontaneous bacterial peritonitis due to extended2spectrum beta2lacta2 mase2p roducing Escherichia coli and Klebsiella species: a retrospective matched case2control study. BMC Infect D is, 2009, 9: 41. 2,,. 2., 2007, 6: ,,, Mohnarin., 2008, 18: ,,,. 2008CH INET., 2009, 5: Dem ir S, Soysal A, Bakir M, et al. nested case2control study. J Paediatr Child Health, 2008, 44: L inares L, Cervera C, Cof n F, et al. Extended2spectrum beta2lactamase2p roducing Klebsiella pneumoniae in paediatric wards: a gram 2negative rods in renal transp lantation. Am J Transp lant, 2008, 8: Meybeck A, R icard JD, Barnaud G, et al. R isk factors for infection with extended2spectrum and AmpC beta2lactamase2p roducing sistant Escherichia coli in ICU: a retrospective study. BMC Infect D is, 2008, 8: 127. Incidence and impact on clinical outcome of infectionswith p iperacillin / tazobactam re2 8 R ibas RM, Freitas C, Gontijo Filho PP. Nosocom ial bloodstream infections: organism s, risk factors and resistant phenotypes in the B razilian University Hosp ital. B raz J Infect D is, 2007, 11: Fankhauser C, ZinggW, Francois P, et al. Swiss Tertiary Care Hosp ital. SwissM ed W kly, 2009, 139: Surveillance of extended2spectrum2beta2lactamase2p roducing Enterobacteriaceae in a 10 Koh TH. Gram2negative resistance in Singapore: a historical perspective. Ann Acad Med Singapore, 2008, 37: ,,,. 6 2., 2009, 24: N icasio AM, Kuti JL, A slanzadeh J, et al. Influence of automated screening and confirmation of extended2spectrum beta2lacta2 mase2p roducing members of the Enterobacteriaceae on p rescribing of antibiotics. J M ed M icrobiol, 2008: 57: Superti SV, Augusti G, Zavascki AP. R isk factors for and mortality of extended2spectrum2beta2lactamase2p roducing Klebsiella pneumoniae and Escherichia coli nosocom ial bloodstream infections. Rev InstM ed Trop Sao Paulo, 2009, 51: SchwaberMJ, Carmeli Y. Mortality and delay in effective therapy associated with extended2spectrum beta2lactamase p roduction in Enterobacteriaceae bacteraem ia: a systematic review and meta2analysis. J Antim icrob Chemother, 2007, 60: ,,,. 2006, 35: BassettiM, R ighi E, Fasce R, et al , Efficacy of ertapenem in the treatment of early ventilator2associated pneumonia caused by extended2spectrum beta2lactamase2p roducing organism s in an intensive care unit. J Antim icrob Chemother, 2007, 60: Kelesidis T, Karageorgopoulos DE, Kelesidis I, et al. Tigecycline for the treatment of multidrug2resistant Enterobacteriaceae: a systematic review of the evidence from m icrobiological and clinical studies. J Antim icrob Chemother, 2008, 62: FalagasME, Kastoris AC, Kapaskelis AM, et al. Fosfomycin for the treatment of multidrug2resistant, including extended2spec2 trum 2lactamase p roducing, Enterobacteriaceae infections: a systematic review. Lancet Infect D is, 2010: 10: Jones CH, Tuckman M, Keeney D, et al. Characterization and sequence analysis of extended2spectrum2beta2lactamase2encoding genes from Escherichia coli, Klebsiella pneumoniae, and Proteus m irabilis isolates collected during Tigecycline Phase 3 Clinical Trials. Antim icrob Agents Chemother, 2009, 53: ,,,. ESBL s., 2009, 9: Clinical and Laboratory Standard Institute. M1002S20: Performance standards for antim icrobial suscep tibility testing. USA Clinical and Laboratory Standard Institute. M1002S19: Performance standards for antim icrobial suscep tibility testing. USA R izvim, Fatima N, Rashid M, et al. Extended spectrum AmpC and metallo2beta2lactamases in Serratia and Citrobacter spp. in a disc app roximation assay. J Infect Dev Ctries, 2009, 3: Le J, Nguyen T, Okamoto M, et al. Impact of emp iric antibiotic use on development of infections caused by extended2spectrum beta2lactamase bacteria in a neonatal intensive care unit. Pediatr Infect D is J, 2008, 27: O rtega M, Marco F, Soriano A, et al. Analysis of 4758 Escherichia coli bacteraem ia ep isodes: p redictive factors for isolation of an antibiotic2resistant strain and their impact on the outcome. J Antim icrob Chemother, 2009, 63:

8 214 () Chin J Exp Clin Infect Dis (Electronic Edition), May 2010, Vol 4, No Bhattacharjee A, SenMR, Prakash P, et al. Increased p revalence of extended spectrum beta lactamase p roducers in neonatal sep2 ticaem ic cases at a tertiary referral hosp ital. Indian J Med M icrobiol, 2008, 26: ( : ) ( :) 2. 2 [ J /CD ]. :, 2010, 4 (2) :