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1、Chinese JournalofNew Drugs2011, 20(3)219null nullS02011M203Tenull 肖永红,教授,博士生导师,主要从事感染a细菌耐药a抗菌药物以及合理用药研究b联系电话: ( 0571) 87236421, Enullmai:lxiaonullyonghong 163. combnull8nullNDM null1W00)S%)F)o(浙江大学医学院附属第一医院传染病诊治国家重点实验室,杭州 310003)null null K1 null 产NDMnull1泛耐药肠杆菌科细菌(主要为大肠埃希菌a肺炎克雷伯菌)对头孢菌素a碳青霉烯类等广泛耐药,主
2、要引起长期住院a应用广谱抗菌药物a免疫抑制a器官移植以及接受侵袭性操作等住院患者感染;细菌仅对替加环素a多黏菌素等少量抗菌药物敏感,临床缺乏有关感染治疗的研究结果;参考其他产碳青霉烯类肠杆菌科感染抗菌治疗研究报道,建议根据药物敏感性测定结果选择抗菌药物,轻症感染可单用阿米卡星a磷霉素a喹诺酮类等,重症感染一般需要联合用药,包括替加环素a多黏菌素a碳青霉烯类a阿米卡星等;加强医院感染控制与合理使用抗菌药物是防止产NDM null1泛耐药肠杆菌科细菌扩散的重要手段b1oM null 产NDMnull1肠杆菌科细菌;替加环素;多黏菌素;医院感染;抗菌治疗ms| R978. 1null null DS
3、 Anull null cI| 1003- 3734(2011)03- 0219- 06Antibacterial therapy for the infections ofNDM null1 producingEnterobacteriaceaeXIAO Yongnullhong(StateKey Laboratory ofDiagnosis andTreatmentfor InfectiousDiseases, TheFirstAffiliatedHospital,SchoolofMedicine, Zhejiang University, Hangzhou 310003, China)A
4、bstract null In isolated bacteria that are fully resistant to antibiotics ( pannulldrug resistant), one type isNDMnull1 producingEnterobacteriaceae (mainly includingEscherichia coli andKlebsiellapneumoniae). Thismay leadto the nosocomial infections in hospitalized patientsw ith longnullterm stay, br
5、oadnullspectrum antibiotic application, imnullmunodeficiency, organ transplantation or invasive operation, etc. Only is the germ susceptible to few antibacterialagents such as tigecycline and polymyxin, and there is no comprehensive investigation about the antibacterialchemnullotherapy for its infec
6、tions. The antibacterial treatment for these infections should refer to the in vitro antibacterialsusceptible test results and clinical study reports for other carbapenamasenullproducingEnterobacteriaceae infections.In principle, amikacin, fosfomycin or fluoroquinolones could be employed singly as t
7、he agents formild infection,antimicrobial combination including tigecycline, polymyxin, carbapenams, amikaxin should be considerations forthe severe infections. Themajormeasures for the controlofNDMnull1 producingEnterobacteriaceae spread are rationaluse of antibiotics and enforcement of nosocom ial
8、 infection prevention.Key words null NDMnull1 producingEnterobacteriaceae; tigecycline; polymyxin; hospital infections; antibactenullrial therapynull null 2010M8nullLancet InfectiousDiseasesnull12Snullnullnull=(New Delhimetallonullnullnulllactamase1, NDMnull1)S%)(/:NDMnull1%)f,%)F)0 32 3 32 / 32 3/:
9、 64/ 64 0 64/ 64 0 64 / 64 0ho 256/ 256 0 256/ 256 0 256 / 256 0h 256/ 256 0 256/ 256 0 256 / 56 0ho 64/ 64 0 64/ 64 0 64 / 64 0w2 64/ 64 11 64/ 64 0 64 / 64 8d 8/ 8 8 8/ 8 8 8 / 8 8iv 32/ 32 3 32/ 32 3 32 / 32 3 32/ 32 0 32/ 32 0 32 / 32 05 64/ 64 0 64/ 64 0 64 / 64 0v16/ 32 0 32 / 32 0 8 /16 09F1/
10、4 64 4/8 56 1 /2 64*)0. 5/8 89 1 /32 94 1 /2 100V2nullF)0)S%)8F)10nullnull)S%)(104)Xu)(60)( 24)M IC50 /M IC90 /mgnullL- 1 S/% R /% M IC50 /M IC90 /mgnullL- 1 S/% R/% M IC50 /M IC90 /mgnullL- 1 S /% R/%9F0. 5/1 100 0 1 /2 100 0 0. 25 /0. 5 100 0*)B 4 88. 1 11. 9 8 66. 7 13. 3 8 50 33. 3 8 58. 3 31. 2
11、 4/ 8 70. 8 20. 828/ 8 37. 5 37. 5 16 / 32 53. 3 13. 3 0. 5 / 4 61. 9 33. 34/ 8 35. 6 19. 2 8 /16 21. 7 46. 7 4/ 8 54. 2 17. 728/ 8 32. 7 50 8 / 8 20 61. 7 8/ 8 42. 9 38. 1d4/ 4 32. 1 60. 7 16 / 16 18. 8 64. 6 8/ 8 33. 3 41. 7ho 16/ 16 26. 2 59. 5 4 / 4 14. 6 79. 2 16 / 16 28. 6 57. 1w2 16/ 16 15. 5
12、 78. 6 16 / 16 10. 4 87. 5 32/ 64 19 42. 9/: 64/ 64 10. 7 73. 1 8 / 32 5 83. 3 16 / 16 9. 5 85. 7128/32 7. 7 73. 1 64 / 64 0 95. 8 8/ 16 8. 3 12. 5Chinese JournalofNew Drugs2011, 20(3)222nullS02011M203V3null)S%)F)0hfZDk/khESBLKPCkXu)9F+iv,57L82Ms8Dk00kXu)9F69UhoDk/khKPCkXu)9F+de?,nullr,nullW49o,/?,W9FM IC9F2 mgnullL-1k00kXu)9F+*)B2!null%),e463,qBKPCv)(9FM IC 0. 75)9FrT53Uh3,nulli,F,(MBL)O*)00kXu)9F743,Uh,/,nullYMBLESBLkXu)9F+*)r663,qB,V?null300kXu)9FrM1k00kXu)2+*)r00kXu)2
