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（李兰娟 吴仲文）
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内科学新进展 第五节 若干耐药致病菌感染近况及抗菌药物治疗的选择
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摘 要 随着临床上应用的抗菌药物日益增多，耐药性问题已引起全球的关注，现将近日研究有关若干主要致病菌耐药概况（包括发生率、耐药机制等）及其感染，抗菌药物治疗的选择等方面作重点阐述。10种常见致病菌感染包括：①耐甲氧西林金黄色葡萄球菌／凝固酶阴性葡萄球菌（MRSA/MRCNS)，并对其耐药机制及对万古霉素耐药（VISA/VRSA）作了重点介绍。②耐青霉素肺炎链球菌（PISP/PRSP)。③肠球菌感染，并对其耐糖肽类抗生素的机制及治疗作了重点介绍。④肺炎克雷伯菌感染，并对其产超广谱β-内酰胺酶（ESBLs）作了重点介绍。⑤铜绿假单胞菌感染，并对其耐药机制中的外膜蛋白（Opr）D2的缺失及主动外排系统作了介绍。⑥阴沟肠杆菌感染，并对其产AmpC酶作了介绍。⑦嗜麦芽窄食单胞菌感染，该菌能水解碳青烯类抗生素而呈多重耐药。⑧鲍曼不动杆菌感染，并对其产 OXA型碳青霉烯酶耐药机制作了介绍。⑨嗜肺军团菌感染，重点对其引起肺炎临床特征作了介绍。⑩李斯特菌感染。
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Abstract The present situation on the infection of antibiotic resistance of some pathogenic bacteria and selection of treatment with antibiotic drugs In the wake of the spread application of antimicrobial agents on the clinical fields, an increasing incidence of the baterial resistance is a worldwide problem. This article is the present situation on the resistance profile of some pathogenic bacteria, it contain the explain briefly about the incidence and mechanism of antibiotic resistance, and its infection with selection of treatment of antibiotic drugs. The infections of 10 common antibiotic resistance of pathogenic bacteria are expounded: ①Methicillin-resistant staphylococcus aureus（MRSA）and coagulase-negative staphylococcus（MRCNS）infections, and some strains of MRSA and MRCNS are found the resistance to vacomycin（VISA/VRSA). ②Penicillin-resistant streptococcus pneumoniae（PRSP/PISP）infections. ③Enterococcus infections, and few strains of E. faecium are found resistance to vancomycin or teicoplanin. ④Klebsiella infections, and some strains of K. pneumoniae producing extended-spectrum β-lactamases（ESBLs). ⑤Pseudomonas aeruginosa infections, and its mechanism of antibiotic resistance about the outer membrane protein（Opr）D2 and active efflux system（MexAB). ⑥Enterobacter cloacae infections, and some strains of E. cloacae producing AmpCβ-lactamases. ⑦Stenotrophomonas maltophilia infections, most strains of S. maltophilia are resistant to multiple drugs. ⑧Acinetobacter baumannii infections, and the producing OXA genotype of carbapenemase. ⑨Legionnaire’s disease, pneumonia is the predominant clinical manifestation of this disease caused by Legionella pneumophilia. ⑩Listeriosis, caused by Listeria monocytogenes.
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