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24.04.2014
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Neu HC. Med Clin North Am. 1987;71:1051
• «
:
!!!
)
:
75-90%
48
48
:
,
,
,
,
–R
MDR
non-MDR
1
3
DR
–
R
,
1
1-2
PDR
–R
Magiorakos A-P et al. Clin Microbiol Infect 2012; 18:268-281
!)
1.
2.
3.
4.
5.
)
5%
Staphylococcus
spp. 21%
Enterobacteriaceae
48%
MDR, XDR
ESBL
MRSA, VISA
Streptococcus spp.
4%
Acinetobacter spp.
14%
MDR, XDR (COS)
OXA-40
Pseudomonas spp.
8%
MDR, XDR (COS), PDR
MBL (VIM-2)
,
,
2011;10:16-25
.
1.
,
Kumar A, et al. Crit Care Med 2006; 34: 1589
1.
,
2.
(-
),
in vitro,
in vivo
303022,9%
302=14,05,
58,7%
<0,001
. .
. – 2013. -
4. – . 26-40
?
,
WHONET
,
.)
K.pneumoniae (2011-2012
:
.)
87,5%
75,9%
92,6%
87,9%
5,4%
4,2%
66,2%
58,2%
83,3%
70,1%
49,6%
46,8%
,
, .
«WHONET»
?
,
WHONET
,
.)
P.aeruginosa
.
(2011-2013
.)
64,8%
35,2%
5,7%
94,3%
86,8%
13,2%
82,4%
17,6%
78,6%
21,4%
67,3%
32,7%
1,9%
98,1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
© . .
90%
100%
A.baumannii
(2009-2011
65,4%
/
34,6%
41,3%
58,7%
48,7%
51,3%
8,9%
91,1%
32,7%
67,3%
7,3%
92,7%
6,0%
94,0%
0%
.)
20%
40%
60%
80%
100%
?
,
WHONET
,
.)
)
P.aeruginosa (n=159)
CAZ
CIP
GEN
AMK
IMI
MEM
POL
,%
1
40,2%
2
13,8%
3
7,5%
4
6,3%
5
4,4%
6
3,1%
7
2,5%
8
2,5%
9
2,5%
10
1,9%
(14
CAZ –
MEM –
; CIP –
; POL –
; GEN –
/
)
; AMK –
15,2%
; IMI –
;
© . .
30,%
25% (
)
48-72
!!!
60%
– 48-72
50%
40%
30%
20%
10%
0%
2
4
6
8 10 12 14 16 18 20 22 24 26 28 30
P.aeruginosa,
. .
2013; 4:26
XDR
P.aeruginosa
:
P.aeruginosa
> 48
:
/
(17
6
<9)
(Hb < 100
):
)
30
P.aeruginosa
P.aeruginosa
10,62
10,5%
30
( 2=7,11; =0,008)
1,1%
3,42
27,3%
6
( 2=8,12; =0,004)
9,9%
C IV
11,87
10,6%
6
( 2=10,1; =0,001)
0%
2,45
37,3%
P.aeruginos
19,6%
0%
5%
10%
15%
20%
25%
nonXDR P.aeruginosa
30%
35%
XDR P.aeruginosa
40%
( 2=6,19;
=0,013)
45%
50%
XDR (Col-S only):
MDR:
III
1.
,
2.
(- ),
in vitro,
3.
in vivo
«
,
«
»
,
»
.
/
-
:
(I S)
T>
:
79
,
APACHE II
17
38
3,375
30-
14-
41
4-6
3,375
4-
:
31,6%
38 (6-131)
14-
8
:
12,2%
21 (3-98)
Lodise TP, et al. Clin Infect Dis 2007; 44:357-363
(1 )
4-
P.aeruginosa
4-8
– R)
– 75%
P.aeruginosa
– 97,2%
Apisarnthanarak , et al. Clin Infect Dis 2010; 51: 1352-4
max/MIC
AUC/MIC
:
:
......
):
<60
: 50 000–75 000
.
3
- 75 000
,
-8 .
.
):
>60
: 1–2
-6
3
.
.
,
80% CMS)
( 20% CMS –
CMS!!!)
(CMS)
)
!!!
–
Plachouras D, et al. Antimicrob Agents Chemother 2009; 53: 3430-3436
1.
,
2.
(- ),
in vitro,
in vivo
3.
4.
)
:
:
in vitro
MDR
:
1.
2.
3.
,
Kumar A, et al. Crit Care Med 2010; 38: 1773-85
Micek S, et al. Antimicrob Agents Chemother 2010; 54: 1742-8
Martinez J, et al. Antimicrob Agents Chemother 2010; 54: 3590-6
Abad C, et al. Crit Care Care Clin 2011; 27: e1-27
)
(cornerstone antibiotic)
+
(adjuvant antibiotic)
in vitro
in vitro
,
,
in vivo
Zavascki, et al. Expert Rev Anti Infect Ther 2013; 11:1333
:
+
in vitro
+
:
77% (95%
64-87%)
Acinetobacter baumannii
44% (95%
30-59%)
Klebsiella pneumoniae
50% (95%
30-69%)
Pseudomonas aeruginosa
1.
,
2.
(- ),
in vitro,
in vivo
3.
4.
)
5.
),
–
:
(-
MDR
Masterton RG, et al. Crit Care Clin 2011; 27:149-162
302,3%
3014%
Joung M, et al. Crit Care 2011; 15: R79
1.
,
2.
(- ),
in vitro,
in vivo
3.
4.
)
5.
),
6.
,
-
.
in vitro
in vivo
.
)
»
!!!
!
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