CLSI三代头孢菌素折点改变及其临床意义

1、1会计学CLSI三代头孢菌素折点改变及其临床意三代头孢菌素折点改变及其临床意义义目前我国的临床微生物实验室均以CLSI文件作为药敏试验指导文件进行操作和报告 拉氧头孢拉氧头孢 南南 “S”结果改成结果改成“R” 除肠杆菌科细菌之外的其他细菌均未进行头孢菌素的折点改变！*对金葡菌和路登葡萄球菌同时进行对金葡菌和路登葡萄球菌同时进行FOX和和OXA药敏药敏时，两者只要有一个结果显示耐药就应该报告苯唑时，两者只要有一个结果显示耐药就应该报告苯唑西林耐药西林耐药BreakpointInterpretive StandardCLSI对头孢菌素类折点改变的临床意对头孢菌素类折点改变的临床意义义Quinol

2、onesQuinolonesAminoglycosidesAminoglycosidesMacrolidesMacrolidesTelithromycinTelithromycinDoxycyclineDoxycyclineTime MICMIC40-50%AUC24/MICMIC25-125*0.75gQ8HDrugDosage CommentCefazolinBreakpoints are based on a dosage regimen of at least 1 g every 8 h.CefepimeBreakpoints are based on a dosage regimen

3、 of 1 g every 8 h or 2 g every 12 hCefotaxime or ceftriaxoneBreakpoints are based on a dosage regimen of 1 g every 24 h for ceftriaxone and 1 g every 8 h for cefotaximeCefuroxime (parental)Breakpoints are based on a dosage regimen of 1.5 g q8 h.CeftazidimeBreakpoints are based on a dosage regimen of

4、 1 g every 8 h.CeftizoximeBreakpoints are based on a dosage regimen of 1 g every 12 h.AztreonamBreakpoints are based on a dosage regimen of 1 g every 8 h.nPatient characteristicsnAge, sex, body mass, pharmacokinetics, immune status, underlying diseasenInfection characteristicsnType of infection, sit

5、e of infection, the stage of he infection, presence of foreign material, vascularisation, oxygenation .nBug characteristics nSpecies, pharmacodynamics, microbiological susceptibility, presence of and type of resistance mechanisms .Likelihood of clinical success and failure is related to many variabl

6、es13296株肠杆菌科细菌头孢噻肟纸片法株肠杆菌科细菌头孢噻肟纸片法药敏药敏 抑菌圈直径的分布抑菌圈直径的分布2008年中国年中国CHINET资料资料使用新折点使肠杆菌科细菌对头孢噻肟的耐药率提使用新折点使肠杆菌科细菌对头孢噻肟的耐药率提高了高了CLSI2009CLSI2010S=45.7%I=10.6%R=43.7%R=54.3%I=4.3%S=41.1%6678株大肠埃希菌头孢噻肟纸片法药敏 抑菌圈直径的分布52.6%9.7%37.7%62.3%62.3%2.2%35.5%CLSI2009CLSI20102008年中国年中国CHINET资料资料使用新折点使大肠埃希菌对头孢噻肟的耐药率提高使用新折点使大肠埃希菌对头孢噻肟的耐药率提高了了2009CLSI2010CLSI 3752株产ESBL大肠埃希菌头孢噻肟纸片法 药敏抑菌圈直径的分布S=0.8%S= 1.4%I=0.5%R=98.6%I=11.4%R=87.3%2008年中国年中国CHINET资料资料使用新折点使产使用新折点使产ESBLs大肠埃希菌对头孢噻肟的耐药率大肠埃希菌对头孢噻肟的耐药率提高了提高了 才能指示临床治疗有