12

1929Flemin1940ChainFlorey

.

1932Domagk1942Waksman

1959Chain6APA1973-

.NCCLSK-BE

-iodometric testnitrocefin test

NCCLS ()

The endThank you

-1. 2. 3. 4.5. 6.-/-

Metronidazole Tinidazole ornidazole

PCR PCR-RFLPPCR-SSCP PCR- DNA

1.- - 2. 3(AAC)(APH)(AAD)3. 4.

OmpF OmpC PhoE OprK

1. 2. 3. DNA

4. -5. PBP , -PBPPBP2aPBP3 6.van

- (Ambler) ( Bush)-Lam C 1 AmpC A 2a PC1 2b TEM-12 SHV-1 2be ESBLs TEM-329, SHV-26 2br (IRTs) TEM30-41,TRC-1 2c PSE-1 CARB-3 2e Cxase 2f IMI-1,NMC-ASme-1 D 2d OXA-1,PSE-2 4 Zinc-Lam B 3 L1

AST

AST

AST S R SFS

ASTRRRSSS

AST ART

AST 1 1.SIR 2.MIC 3.E testMIC2 VitekMicroscan Phoenix3 PCRmecA4 NitrocefinESBL

AST R I S MIC-time above MIC %=MIC90h /htimeMIC=40~50% good 60~70% very good1

- 123 PAE MIC

PAE

4 PAE

AST ()() () ()MRS, PRP, VRE, ESBL

AST WHONET

AST ASTART Medical choice Bacteriological choice

MH,MICMBCMIC

()

MICMIC

E Epsilometer testE5mm50mmg/ml15-20

E

MIC16mg/L

DNA

-

1 D-

2D-Ala-D-Ala -

--

pBp

1 GV methacillin oxacillin cloxacillin

2G(ampcillin)(amoxicillin) - ,(carbenicillin)(ticarcillin)

2 , (mezlocillin)(azlocillin)(piperacillin) +- - -ampicillin-sulbactam(unasyn);-()ticacillin-lavulanate(Timentin);-()amoxicillin-clavulanate(Augmentin);- piperacillin-tazobactam

(cephalosporins)7- - ,

,PBP,PBP,,

- -,3--,,PBP3,,, ,(aztreonam,) -

-

1. (cephamycins) 2,(cefoxitin)(cefotetan) (cefmetazole) -,,

-

2. (moxalactam) ,,,-,

- -,MRS(impenem)(meropenem)(biapenem)(panipenem)

-

---

21,

30S

mRNA ,

(quinolones) 6,7 DNA(II)DNA,DNA

14~16,,5,3

50S23S,,

67,, 30S,RNARNA,,

70S50S,

50S,,, lincomycinclindamycin,

D DD-D

, MRSBE

,,F() SMZ/TMPSD/TMP

(sulfamethoxazoleSMZ),(sulfadiazine,SD)(sulfamethoxypyrazine,SMPZ)

isoniazid,INHrifampin,RMPpyrazinamide,PZAethambutol,EMBstreptomycin,SMparaaminosalicyclic acid,PASethinamade,TH1314cycloserin,CScapreomycin,CPMkananycin,KMrifabutin

ADC AC BC A