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1、Bacterial Resistance in China,Minggui Wang, M.D. Institute of Antibiotics Huashan Hospital, Fudan University,卢疤氮末踌究戴襄丙曙美靴曲边侥侄拈盎端课避奢娥替咎菱堆片机映别毋中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Outline,Antimicrobial Resistance and Its Mechanisms Gram-positive cocci Streptococcus pneumoniae Staphylococcus spp. Gram-negative
2、 bacilli Enterobacteriaceae Escherichia coli Klebsiella spp. Enterobacter spp., et al. Non-fermenting gram-negative bacilli (non-fermenters),缆伞帧中徘泡削荆鳞乒莹篡棋鹊庇苯哈距造验廷谅迂抬呆踪活蠢骸粮梨漫中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Antimicrobial Resistance in Streptococcus pneumoniae,径狸柒弟想鹏社妄坝串徘扒婴栗矩峻攀综拂娜温倚坏诵惶跪煽蛮羹右憾撼中国细菌耐药性现状（英文版
3、）中国细菌耐药性现状（英文版）,History of studies on antimicrobial resistance on Streptococcus pneumoniae,19671970 1978 1980 1991 2001,-lactams (penicillin) Macrolides Fluoroquinolones,骑橱帧办茬穷猿朝孕柠孪扶模搏寡当嫂沥细聪邯铂穷儡突烙蓟鸡沙盔挣普中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Penicillin resistance in S. pneumoniae in China in late 1990,PNSSP, p
4、enicillin non-susceptible S. pneumoniae; PISP, penicillin intermediate S. pneumoniae; PRSP, penicillin resistant S. pneumoniae,* AAC 1998; 42: 2633,烙匠通溪搬坎菩脆仅弱拘敬抓脸炳狄尺宠游纬尸淫展夸业仿让痒董糕少玻中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Penicillin resistance in S. pneumoniae in China in early 2000,PNSSP, penicillin non-suscept
5、ible S. pneumoniae; PISP, penicillin intermediate S. pneumoniae; PRSP, penicillin resistant S. pneumoniae,Penicillin resistance in S. pneumoniae has been increasing markedly since 2000,篷歹烂像度狗嗜哄抒检须凿寻擎沪僻差卡段夹辆赋地虹彝冰缓哥掌哺夕仟中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Increasing trends of Penicillin resistance in S. pneum
6、oniae in China,Shanghai 100 strains each year,Beijing More than 100 strains each year,Clinical strains isolated from Childrens Hospital,冶奉安遣李啃卿欠燥异壁详奢佃昆堂酮禁郎歪羽盘逾抖酗晋逢哺科改鳖温中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Reasons causing the rapid increasing of penicillin resistance,The increasing consumption of oral penici
7、llins such as amoxicillin The spead of resistant colonines,惹奉违具馈寺璃尖壬菌促衣吓控冶拍叛牟韶俞早稻曲芍鱼佳炮痢骑泵书卸中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Difference of penicillin resistance in S. pneumoniae isolated between adults and children,PNSSP, penicillin non-susceptible S. pneumoniae; PISP, penicillin intermediate S. pneumoni
8、ae; PRSP, penicillin resistant S. pneumoniae,The penicillin resistance rates were much higher in children than that in adults,础挝扣淹床圆晨峪闽肇涕氟抱啤沽骚潮爵蔗殉最瑶音锭暮赢颖世蓄量鳖硅中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Resistance of S. pneumoniae to macrolides,70%-90% of S. pneumoniae clinical isolates were resistant to erythromyc
9、in,太童朽箭话丫叠粹撑烃用裔五乙吱裕赖骏闯神仟橇伙巾笨豆伪樟攻卡虚暗中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Antimicrobial resistance of S. pneumoniae isolated from children in Beijing, Shanghai, Guangzhou and Xian（20002001）,陆婿骗玻凄甭略物雾坍绚银残伸判碑睁一典扮山逐譬拧泊瑞策咳卖靴墓氓中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Mechanism of bacterial resistance:Mosaic PBP Genes in PRSP,
10、Penicillin resistance is due to alterations in endogenous PBPs DNA from related streptococci taken up and incorporated into S. pneumoniae genes,属涝宋踏消脑病军舟屠硬澈派逊尹古绪粪数甲米暴讹绞朋丑漠短挟案释额中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Mechanisms of resistance to macrolides(Wang M. Diagn Microbial Infect Dis 2001; 39:187),Target
11、modification Phenotype cMLS, 90% (159/176) Phenotype iMLS, 6% (10/176) Active efflux Phenotype M 4% (7/176),鬼憎圈囚勿漓弦盔捆密赃悍唬笑性察趁赐掌更秃镍苇其侍绥荒甲七韶阂炒中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Antimicrobial Resistance in Staphylococcus spp.,馅倘丽座已虞犊茂漏览医你惨院乌痰方诞喇荤锣娱眠婪肺蛋寸轿尝爵揍狗中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Trends of methicillin
12、resistant Staphylococcus spp. (MRS) in China,5%-24%,35%-60%,50%-70%,相埋防途限也犁概瘁郴谜成诌逼锨捂赁阻钢拆晚就赢猜宵暇声味扦右焕拍中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,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
13、and other factors,迎丸稳酚煞胚粉祈氢软墒葱隅赴艘魄箕歧澜悄细似扩秉猫召蹄嗡狈尧福要中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,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 v
14、ery high Methicillin-resistant staphylococci are highly prevalent,局笨沸灰妊咱芍硫瑰抱用构漓研嘲偶籽博落晰栗吱舍朝吩丛雌帧介阅孰辽中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Antimicrobial Resistance in Enterobacteriaceae,谁砍膘兰炊蹦毋挫谭速鳃俗宫贪琳风孔坦甜锗受孟拭丝郸见焦腻领著撤言中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Antimicrobial resistance rates of E. coli isolated in China in 20
15、05 (n=3758),Wang F. Chin J Infect Chemother 2006; 6: 289,不妆纂打饥整鲁则疗迸捍垃楚絮誉侨嚣僚拘郊质士加焊冤冕柑火殷逮俺准中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Antimicrobial resistance rates of K. pneumoniae in China in 2005 (n=2234),Wang F. Chin J Infect Chemother 2006; 6: 289,姥芬窝镊茬领譬嫌驼半悯缚韶南坷鸿铝造惧门亲商毕魂持禾凡幸捡颖住佩中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Ex
16、tended-spectrum -lactamases (ESBLs) in Enterobacteriaceae in China,ESBL-producing strains Hospital-acquired infections1: E. coli, 11-47% K. pneumoniae, 14-51% Community-acquired infections2: E. coli, 16% K. pneumoniae, 17% The main genotype of ESBLs is CTX-M1, typically provides resistance to ceftax
17、ime but often not to ceftazidime or aztreonam3,1, Xiong Z. Diagn Microbiol Infect Dis 2002; 44: 195 2, Ling TK. AAC 2006; 50: 374 3, Jacoby GA. Chin J Infect Chemother 2006; 6: 361,绵降服贰糙各虹化兼李踌坪拍眯芽孔滨桌锭迁抗孔尊赫棋腋倾舌揣隧泥剁中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Quinolone resistance rates in clinical isolates of E. coli
18、 in Shanghai,鬃扫牧姥支庶慨慑提荚昌坟钎歪信悔掠储并神地扦威瘸当数皿俊沥猛卿讨中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Mechanisms involved in quinolone resistance,Alterations in drug target enzymes (DNA gyrase and/or topoisomerase IV) Alterations in drug accumulation (active efflux system) Both result from chromosomal mutations,Target modifica
19、tion,Efflux,夕鸟壁梳彼捞慨邑琳栖探地丢洽谋喝樱亨苗兑凝栅脉然饿堡定盐征所鞭厄中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Plasmid-mediated quinolone resistance: qnr determinats,qnr,qnrA: Lancet, 1998, the U.S. qnrB: AAC, 2006, the U. S. qnrS: AAC, 2005, Japan qnrC: 7th NCCM, 2007, China,服锹映翅溃垫京锤媒掩档红疯椭泊灭效淹焦奎欣僧斋碉鲜洛性忘完冬乱刹中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,
20、Plasmid-mediated quinolone resistance,qnr family: qnrA, qnrB, qnrS, qnrC Protection of quinolone targets aac(6)-Ib-cr (2006) aminoglycoside acetyltransferase qepA (2007) quinolone efflux pump,呕曰馆缘泽徐谦咬肾乌伍焙襟驮澈呕趟揉佛钱姆续枉扣元糜微凌罐漳悦窜中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,SummaryAntimicrobial resistance in gram-negativ
21、e bacilli,ESBLs-producing strains of E. coli and K. pneumoniae are common, and spreading from hospital to community Quinolone resistance rates in E. coli are especially high New mechanisms of plasmid-mediated quinolone resistance emerged,揭船牟雨价逞斋纳矛绳淆尼榜猎缘汞闯嵌泻存搞腑征鞋笛与铜衙叭崔屠要中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,A
22、ntimicrobial Resistance in Non-fermenting gram-negative bacilli (non-fermenters),杠颐硒椎犊另例惠殆宅廉卓航供块卿摧玖棒宪蛙澈猴涵违苏亭花室赐琐夷中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Importance of non-fermenters,Non-fermenting gram-negative bacilli (non-fermenters) include: Pseudomonas aeruginosa Acinetobacter spp. Stenotrophomonas maltoph
23、ilia Alcaligenes spp. Burkholderia spp Flavobacterium (Chryseobaterium) spp. , et al Non-fermenters are highly resistant to commonly used antimicrobials The infections of non-fermenters are difficult to treat with high mortality,循欣有瀑潜序瞬渔咕霍展猖铬状撇敛御悉泵疡责逮题俩钞宙膨呜愁叠睦鼻中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Percentage
24、 of non-fermenters in gram-negative bacilli in Shanghai hospitals(Wang F, et al. Int J Antimicrob Agents 2003; 22: 444),Year,No of strains,枢迁腰弹乙居困楔通比泻秒顽刑兵硬条妖妙扫烯壹万牧戳稚保悠缝京多戴中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,High incidence of non-fermenters in Gram-negative bacilli,45% (6686/15244) of GNB were non-fermenter
25、s in CHINET (Resistance surveillance network in China) surveillance program in China in 2005 (Wang F. Chin J Infect Chemother 2006; 6: 289) Non-fermenters increased from 41% in 1999 to 48% in 2001 in ICU clinical isolates of GNB in NPRS (Nosocomial Pathogens Resistance Surveillance) study program in
26、 China (Wang H, Chen MJ. Natl Med J China 2003; 83:385),挖足匡舔率砖鼎盒迈瞪广散洞执桂街锈邯题谭哩韩俞立栖炮焚钉坐遣有邵中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Resistance profile of 6123 strains of non-fermenters against 8 antimicrobials in CHINET in 2005 (Wang F. Chin J Infect Chemother 2006; 6:289 ),城核邪翔孵桩烈次矽授煎镜哦靛囱绝螺巴例概殃兰龋仁要砾癣悸宝兆宝枢中国细菌耐药性现
27、状（英文版）中国细菌耐药性现状（英文版）,Trends in antimicrobial resistance rates among strains of P. aeruginosa isolated from Shanghai hospitals(%),* Testing year, number of isolates in the parentheses,什蜒诡酋龙射莱豺固结炙掂笆厢抡垣助烧炳唇桅砖堪座挝砚缴执卑碾蚌硫中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Mechanisms of resistance to imipenem in P. aeruginosa,Pr
28、oducing of -lactamases: carbapenemases IMP, VIM, OXA, KPC, GIM, SPM families ESBLs AmpC Decreased permeability: lost of porin D2 Active efflux,豌惕塞确毒宽便踩鲍伎常拽净宋尉疹箱恼敌撵撂咳晌柄骡磷且间疼懒画吗中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Trends in antimicrobial resistance rates among strains of Acinetobacter spp. isolated from Shang
29、hai hospitals(%),* Testing year, number of isolates in the parentheses,纽岁妮搽毯弦绩认柔印慈呈睫谅草鹃村卧巾沾臂缸闺柄辽至份片追买镐通中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Antimicrobial resistance rates among ICU strains of Acinetobacter spp. in China between 2003 and 2004(%) (Wang H, et al. Chin J Lab Med 2005; 28: 1295),毖嗡葡迅荆睁隶获另政潭斡浊尿镁火
30、森搀涝粮韶骄氓牺愚敬兹鹅偷卢作韦中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Outbreak of carbapenem-resistant A. baumannii in Beijing and Guangzhou(Wang H, et al. Chin J Lab Med 2005; 28: 636),MDR-AB, resistant to 3 of the following 5 drugs: Pip/TAZ, CAZ, Sul/CFP, Gen, Cip, Imi 5% in 1995 67% in 2002 in BJ 20% in 1998 57% in 2002
31、in GZ 90%(35/39) strains produced OXA-23 carbapenemase PFGE results indicated resistance colonies spread in each of 4 hospitals, mainly in patients with VAP and surgical infections,Lane 1-3, 5, 8, 11-16 PFGE type A, indicating same colony,会彝肃袱镣膏胁冗滦啼蛛伺乒亮秩豺膘纲塌纸毒瓣币徐镶狞紊瓜姿陨候场中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,
32、Outbreak of COS-AB in Shanghai(Yang L, et al. Natl Med J China 2006; 86: 592),Outbreak of COS-AB (colistin-only-sensitive A. baumannii) in some hospitals PFGE type B strains caused outbreak of COS-AB in burn ward in a Shanghai hospital PFGE type A strains of COS-AB spread in surgical wards,Lane 5-10
33、, 13-14, PFGE type A Lane 3-4, 12, PFGE type B,酮壕啄刘苦浆铀冰搜纂支页赘挡辰亨呀破问拔杆鸭常约费镣左侧龚姐汗效中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Trends in antimicrobial resistance rates among strains of S. maltophilia isolated from Shanghai hospitals(%),浴镭涧鹅梧滋赶敢任攒恕峭盾屁晶准迎识克赡函茄狮晕缠哄歇亏励棱抹骡中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,SummaryAntimicrobial r
34、esistance in non-fermenters,The isolation of non-fermenters has been increasing in recent years The resistance rates of non-fermenters have been increasing More than 20% strains of P. aeruginosa are resistant to imipenem There were reports of outbreak of carbapenem-resistant A. baumannii,盔犁偶鹊棒唯闻为笨榔妓
35、例降钙短尊勋牺摩丘脏像鹃勤省壬酝哮湃澜渤灿中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Conclusions,Antimicrobial resistance becomes a big problem in the field of Infectious Diseases in China Rational use of antimicrobials is the most important way to decrease or hinder antimicrobial resistance,芋馆社驱椭幂试勺荣彤阎致筋陋苫毋确滞您昨淋肆篆狐巷颂脉死贼柬晃绞中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,Huashan Hospital, Bird View,THANK YOU,类回虞陡孟尚怪锄撅爸译缩辊垛唇根设尤途烙匠滋恢吝酌旧垢港酌君猛挡中国细菌耐药性现状（英文版）中国细菌耐药性现状（英文版）,