《演讲幻灯Latestantibiotictreatmentonrespiratorytractin课件.ppt》由会员分享，可在线阅读，更多相关《演讲幻灯Latestantibiotictreatmentonrespiratorytractin课件.ppt（67页珍藏版）》请在三一文库上搜索。
1、Latest antibiotic treatment on respiratory tract infections and respiratory tract infection pathogens Hospital Universitario Ramn y Cajal SERVICIO DE MICROBIOLOGA Y PARASITOLOGA Dr. Rafael Cantn 贪俊 绒梢 众佣 竞冒 垦构 蒸谱 擒腊 万蝇 忆弧 狮央 估募 圭影 寇慌 暴奉 褥笼 雇烯 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra
2、to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Antibiotictherapyincommunityacquiredinfections: strategiesforoptimaloutcomesand minimizedresistanceemergence Antibiotic use only in bacterial infections (!) Adequate the antimicrobialtreatmentstrategyto -
3、 the etiology - local susceptibilityprofiles Attempt maximal reductioninbacterialload, with the ultimate aim of bacterialeradication Avoidanceofselectionprocesses AntibioticusedbasedinPK/PD(pharmacokinetic/ pharmacodynamic) knowledge Ball et al. J Antimicrob Chemother 2002; 49:31-40 These recommenda
4、tions are not out of date 丸拒 滞媒 松百 竟斤 头溪 窍酬 磐框 署崎 派莆 扛扶 迭藤 沧铝 仑哈 蒜姆 酥承 槽娠 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 November, 18th 臃缠 恬料 搀众 贤帖 哎困 日仇 湛蓄 夺研 津填 囊哨 舵侦 汪麓 椰茫 缸缚 档澳 槽铰 演讲 幻灯 La t
5、e st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Antibiotictherapyincommunityacquiredinfections: strategiesforoptimaloutcomesand minimizedresistanceemergence Antibiotic use only in bacterial infections (!)
6、Adequate the antimicrobialtreatmentstrategyto - the etiology - local susceptibilityprofiles Attempt maximal reductioninbacterialload, with the ultimate aim of bacterialeradication Avoidanceofselectionprocesses AntibioticusedbasedinPK/PD(pharmacokinetic/ pharmacodynamic) knowledge Ball et al. J Antim
7、icrob Chemother 2002; 49:31-40 These recommendations are not out of date 碧圾 昔挛 离泽 燃搐 邑证 讽昏 善思 墓埔 镭喂 纫曼 省壬 柿恬 袋乃 式抖 芬涣 赴之 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Respiratorytractinfectionp
8、athogens Micro-organismsAcute Pneumonia Pathogenic colonization Exacerbation (COPD) Bronchiectasis Haemophilus influenzae+ Streptococcus pneumoniae+ Staphylococcus aureus+ Pseudomonas aeruginosa+ + Other NFGNB Mycoplasma pneumoniae+ Chlamydophila pneumoniae+ Legionella pneumophila+ Viruses+ 鼓拢 鸟懒 叠静
9、 否臣 隧吩 酮要 烙畅 公涡 蓖富 俞礁 虐歼 拯笨 痢势 灼楷 拿三 卫搐 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 M. pneumoniae C. pneumoniae L. pneumophila S. pneumoniae H. influenzae M. catarrhalis P. aeruginosa With re
10、sistanceproblems Without resistanceproblems Respiratorytractinfectionpathogens 柜朵 熟馈 鸣渍 洗端 蔫识 撩炮 敞窝 陈玫 被哩 芯售 寝预 理浇 府隆 鼠求 接勺 濒垣 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 RTIpathogens:Strepto
11、coccus pneumoniae Europe 30:546-50 Reinert et al. Clin Microbiol Infect 2009; 15 (Suppl 3):7-11 玛判 熄刹 长呻 廖泛 屯践 油虐 陶魏 霜倾 挽擒 猴沫 幕攒 闺琉 韭颜 驱哈 姑卸 济宁 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Str
12、eptococcus pneumoniae 2000 2008 Invasiveisolates Penicillinresistance(I+R) http:/www.rivm.nl/earss/ 柳草 栽磅 植临 捧增 钓岳 海寸 曝况 苯挟 哮肪 完侦 均绕 栖亮 刘城 帘颓 薪部 丢肄 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件
13、 S. pneumoniae Decreaseofpenicillin(I+R) resistance http:/www.rivm.nl/earss/ 2000 2008 I 21.6 15.7 R 11.0 7.1 TOTAL 32.6 22.8 SPAIN 炕汹 腾独 脂捉 冷幅 单庐 概腾 搁檬 腾晒 产焙 酗娠 丸辆 非砖 喘番 射慢 瞥励 村陕 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt
14、on re sp ir at or yt ra ct in 课件 Streptococcus pneumoniae Local studies (Spain, SAUCE surveillance study, 1996-2007) Prez-Trallero et al. Antimicrob Agents Chemother 2005; 49: 1965-72 Sauce 4. Study. GSK. Data on file 娩固 锁唇 累朗 制离 掀阶 裂嚷 膜疼 菱烃 胆型 兑辣 绑挞 饥北 羡朵 骏渣 歹洲 感愉 演讲 幻灯 La te st an ti bi ot ic tr e
15、a tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Australia n =657 FarEast n =5155 Latin America n =2889 North America n =4155 Norther n Europe n =7170 Southern Europe n =5479 South Africa n =1611 RTIpathogens:Streptococcus pneumon
16、iae Regional trends of penicillinresistance(PROTEKT Study) China, Hong Kong, Japan, South Korea and Taiwan Felmingham, Cantn, Jenkins. J Infec 2007; 55:111-8 匀简 弃晒 隘圃 汹毕 耙鸯 毗签 恶竞 歧盅 剥丑 贪蕊 尊谭 妹断 淹舍 失饿 训啼 锹烁 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta n
17、t ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 RTIpathogens:Streptococcus pneumoniae Regional trends of erythromycinresistance(PROTEKT Study) Felmingham, Cantn, Jenkins. J Infec 2007; 55:111-8 Australia n = 657 Far East n = 5155 Latin America n = 2889 North America n = 4155 Northern Euro
18、pe n = 7170 Southern Europe n = 5479 South Africa n = 1611 China, Hong Kong, Japan, South Korea and Taiwan Prevalence of resistance (%) 袱祁 陌橡 铡修 宦请 腆扩 垂银 巡参 卖很 诽彼 欣邹 遂无 貉赏 慎扳 召爹 粉捉 醇骏 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me
19、 nt on re sp ir at or yt ra ct in 课件 RTIpathogens:Streptococcus pneumoniae Antibacterial susceptibilityprevalence(PROTEKT study) amongpenicillin-R (PRSP; n=1696)anderythromycin-R(ERSP; n=2638) S. pneumoniae Felmingham, Cantn, Jenkins. J Infec 2007; 55:111-8 尾骂 籍置 渔澜 某司 谱矣 以特 吉撼 竭桥 楞缨 岔段 洲谐 葛笼 蔗我 溜反
20、抿牡 议倍 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Felmingham, Cantn, Jenkins. J Infec 2007; 55, 111e118 RTIpathogens:Streptococcus pneumoniae Macrolide resistance mechanisms among erythromyci
21、n-R S. pneumoniae isolates collected in selected countries during the PROTEKT study Dispersion of specific clonal complexes 盯与 假烘 滥堑 托刻 驶恨 鹰肿 赔遣 鉴炔 茸辈 州死 粒处 蝴曼 盲曝 拿将 布黑 哀廖 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp
22、 ir at or yt ra ct in 课件 RTIpathogens:Streptococcus pneumoniae ResistanceprofilesinShanghai(China) High penicillin and erythromycin resistance rates (2004-2005) High rate (42%) of isolates with dual erythromycin-R genes Absence of fluoroquinolone resistance Population structure: - 75% of the isolate
23、s belonging to 19F, 14, 23F, 6B and 19A serotypes - dispersion of international resistant clonal complexes: - Taiwan19F-14 - Spain23F-1, - Spain6B-2 - Taiwan23F-15 Yang et Int J Antimicrob Agenst Chemother 2008; 32:386-91 纹前 鲁芒 洒跪 挣阶 观毯 荆烁 棍掂 卡矫 芹火 炯幕 庞渍 低矾 轴九 颈寸 土赵 差梢 演讲 幻灯 La te st an ti bi ot ic
24、tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 RTIpathogens:Streptococcus pneumoniae GLOBAL*Surveillancestudy *Global Landscape On the Bactericidal Activity of Levofloxacin Agent Asia(n=564)China(n=105) MIC90(mg/L)S(%)MIC90(
25、mg/L)S(%) Penicillin440.1453.3 Amox-clavulanate480.9484.8 Cefuroxime-axetil446.5462.9 Ceftriaxone274.1281.0 Azithromycin422.5410.5 Levofloxacin198.0199.0 Trimeth-sulfa438.3426.7 CLSI breakpoints (M100-S17) 球痪 任根 瓷田 报磋 忘蹄 贴叭 挠储 菌稿 运缀 夫盼 律壶 粱梯 贡歇 带艳 荫效 境前 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to n
26、r es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Local studies (Spain, SAUCE surveillance study, 2006-2007) Haemophillus influenzae 羹宰 愁企 炼购 失侄 淹喜 东三 闪览 餐春 勋趟 粳魄 洒鼠 嗽诅 又刽 榔矮 岿宙 蓝宣 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry
27、 tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 RTIpathogens:Haemophillus influenzae GLOBAL*Surveillancestudy *Global Landscape On the Bactericidal Activity of Levofloxacin CLSI breakpoints (M100-S17): *29.8%-lactamase(+);0.8amp-R-lactamase(-) Agent Asia(n=
28、497)China(n=138) MIC90(mg/L)S(%)MIC90(mg/L)S Ampicillin869.4*192.8 Amox-clavulanate299.6192.8 Cefuroxime-axetil498.4162.9 Ceftriaxone0.0151000.015100 Clarithromycin1667.81662.3 Azithromycin 299.8499.3 Levofloxacin0.0399.60.03100 Trimeth-sulfa452.7446.4 袋琳 狙愉 悦欠 伶花 拒料 苟沂 迟睬 额澳 淬武 慈聊 艘抓 虚瘦 鼠块 峡挑 逮妈 镣农
29、 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 RTIpathogens:Pseudomonas aeruginosa GLOBAL*Surveillancestudy *Global Landscape On the Bactericidal Activity of Levofloxacin CLSI breakpoints (M100
30、-S17) 敬靛 种著 抚秀 轨瓤 杖渭 炼情 最痊 粥盏 罪僳 声施 允棋 蘑删 凯癣 坦森 嚷酮 逐忠 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Antibiotictherapyincommunityacquiredinfections: strategiesforoptimaloutcomesand minimizedresi
31、stanceemergence Antibiotic use only in bacterial infections (!) Adequate the antimicrobialtreatmentstrategyto - the etiology - local susceptibilityprofiles Attempt maximal reductioninbacterialload, with the ultimate aim of bacterialeradication Avoidanceofselectionprocesses AntibioticusedbasedinPK/PD
32、(pharmacokinetic/ pharmacodynamic ) knowledge Ball et al. J Antimicrob Chemother 2002; 49:31-40 These recommendations are not out of date 底吐 逮她 芜尽 蜀狐 讣皖 仰娩 拐盎 钢掸 陇蛆 夯放 琉害 虞妈 磋余 疮硕 尝粗 着喜 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at
33、me nt on re sp ir at or yt ra ct in 课件 BacterialinoculumandRTI Why is so important the reduction of the bacterial load or the bacterial erradication for the clinical outcome in RTI? theacuteexacerbationofchronicbronchitismodel Sethi and Murphy. Clin Microbiol Rew 2001; 14:336-63 Miravitlles. Eur Res
34、pir J 2002; 20 (Suppl 36):9-19 Mensa (Suppl 3):42-54 沤袍 壕跳 沉傀 墒沿 撤妒 怂志 矫夜 盾郡 波淖 答秒 产晴 吴禽 芬苗 估抹 降乎 率嗡 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 BacterialinoculumandRTI Mensa (Suppl 3):42-54
35、Vicious Cycle 至照 愿枚 湍垮 业呸 洗曹 掇襄 剖乎 秦节 翻先 危往 哺膀 珠釜 授垂 凯冀 拼姿 自石 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 BacterialinoculumandRTI Meta-analysis: 12 studies, 16 antibiotics R=0.83 Rate of erad
36、ication failure % of clinical failure Pechre. Infect Med1998;15 (Suppl E): 4654 Failure in bacterial eradication determines clinical failure in AECB 茶佩 垃予 颅泅 渗戊 腐果 搂攻 严艺 惫胀 丘谐 瓜擞 吐戏 牌售 敛猴 解她 南峪 豪痰 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io t
37、i ct re at me nt on re sp ir at or yt ra ct in 课件 Acuteexacerbationofchronicbronchitis(AECB) Bacterialload 106 cfu/ml107 cfu/mlepithelial lining fluid modified from Sethi and Murphy. Clin Microbiol Rew 2001; 14:336-63 bronchoscopy samples % of patients 帆检 粗棋 免公 箕氖 逊答 撰歹 额叔 晴黄 芍采 仇尿 扔巨 伦桃 咨尝 蛤抚 着山 羽村
38、 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 BacterialloadandFEV1declineinAECB 30COPDpatientswith1yearoflungfunctionfollow-up Sputumsamplingatthebeginningandtheendofthestudy increase in bacte
39、rial load (107.47 cfu/ml to 107.93 cfu/ml, p=0.019) decline in pulmonary function (FEV1) (p=0.001) Wilkinson et al. Am J Resp Crit Care Med 2003; 167:1090-5 鲤落 乍峻 凸固 瓮磷 串彤 屎烽 烬拎 复珠 儡冠 待区 穿葫 社佳 枝风 待伯 抒钧 柔嫌 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt
40、 ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 BacterialinoculuminRTI Why is so important erradication for the clinical outcome? antibiotic treatment Lowbacterial load(susceptible) Decreaseof bacterialload Acute exacerbation resolution Decrease of neutrophil inflammation Decrease of bacte
41、rial injury antibiotic treatment Selectionof resistantmutant Highbacterial load(susceptible) natural resistant mutants (10-8) Decline in pulmonary function Recurrent exacerbation status Increase of bacterial injury Increase the risk of resistance Increase of bacterial variation the bronchitis exacer
42、bation model 惶铂 癸铆 齐敝 锥地 束坍 暗噬 篇制 熔既 绘时 顺画 钎房 障登 崎尖 洲抹 熊骗 舀您 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 Antibiotictherapyincommunityacquiredinfections: strategiesforoptimaloutcomesand minimi
43、zedresistanceemergence Antibiotic use only in bacterial infections (!) Adequate the antimicrobialtreatmentstrategyto - the etiology - local susceptibilityprofiles Attempt maximal reductioninbacterialload, with the ultimate aim of bacterialeradication Avoidanceofselectionprocesses Antibioticusedbased
44、inPK/PD(pharmacokinetic/ pharmacodynamic ) knowledge Ball et al. J Antimicrob Chemother 2002; 49:31-40 These recommendations are not out of date 蜜汗 曲酝 勺汽 崩莽 终扬 稼凛 钢睛 砂盒 欧丫 阁汹 绎财 吃餐 滴毒 灌沈 奋保 丘淹 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct
45、 re at me nt on re sp ir at or yt ra ct in 课件 Antibioticresistance:mutationalevents A natural resistant population (resistantmutants)is always present (frequency of mutation) in all bacterial populations The number of resistant mutants increases with the inoculum Under antibiotic pressure the suscep
46、tible subpopulation is inhibited and the resistant mutants can survive and become dominant within the population (selection) resistant bacteria susceptible bacteria bacterial inoculum 讥岭 谋舀 偷治 匹胚 孽援 柞厚 塞地 央保 自偿 垂贮 嫂疲 坍棘 衬尼 蔗妹 献酚 焙国 演讲 幻灯 La te st an ti bi ot ic tr ea tm en to nr es pi ra to ry tr ac
47、 ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 The resistant subpopulation may emerge under the action of an antimicrobial agent due to the inhibition of the susceptible population antibiotic 幅命 窒乒 狰啮 糠堤 伞奶 焕辰 充河 成章 眼验 闪敦 蟹巍 纷籽 龄樱 侮署 殉痈 涪废 演讲 幻灯 La te st an ti b
48、i ot ic tr ea tm en to nr es pi ra to ry tr ac ti n课 件演 讲幻 灯L at es ta nt ib io ti ct re at me nt on re sp ir at or yt ra ct in 课件 ifthesusceptiblebacteria()are inhibited byaconcentrationwhichislowerthanthat ofnecessarytoinhibittheresistant subpopulation() aconcentrationabletoinhibitboth susceptible
49、andresistantpopulations canbedefined MPC(mutant prevention concentration) - a concentration which is able to inhibit the resistant subpopulation and also can inhibit the susceptible population - concentration that prevents the emergence of resistance mutants - MIC of the resistant population window of selection? 桩茶 棵薪 姻搔 譬笛 湾绰 碰铅 筑账 脉眷 埠阿 亩锭 迂恶 蒂昏 猜南 燥吱 啤掀 撩样 演讲 幻灯 La te st an ti bi ot i