念珠菌流行病学.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2019/11/27,Only for Internal Discussion,should nor for promotion,#,Only for Internal Discussion,should not for promotion,Confidential document,only for internal communication,Vfend Brand Team 2014,真菌药敏流行病学数据及研究热点,驱动临床创造更佳的治疗时机,Feasible Fungal Diagnosis,CHIF-NET 2012,年数据尚未发表，仅限内部学习严禁外传,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,2010,年,CHIF-NET,成员单位,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,医院,代码,省,医院,代码,省,北京协和,PU,北京,辽宁人民,LR,辽宁,北大一院,BD,北京,医大附一,Z1,辽宁,解放军总,GH,北京,宁夏总院,NX,宁夏,福建协和,FJ,福建,山东省立,SD,山东,广医附一,G1,广东,上海瑞金,RJ,上海,中山一院,GZ,广东,华西医院,HX,四川,哈医大四,H4,黑龙江,天医总院,TZ,天津,哈医大一,H1,黑龙江,浙大附二,Z2,浙江,武汉同济,TJ,湖北,浙大附一,ZD,浙江,中南湘雅,XY,湖南,浙江人民,Z3,浙江,江苏人民,JS,江苏,浙邵逸夫,ZS,浙江,2012,年,CHIF-NET,成员单位由,12,家增加到,22,家,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,菌株量：,CHIF-NET 2012,：,1619,株,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,标本类型分布,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,门急诊,-,住院分布,/,科室来源,*其他科室包括,：五官科 老年科 妇产科,儿科,VIP,病房,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,念珠菌种类分布,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,菌种鉴定及检出错误,CHIF-NET12,总数,一致,显著错误,非显著错误,白念珠菌,701,97.9%,2.1%,热带念珠菌,268,89.9%,9.7%,0.4%,近平滑念珠菌,202,81.7%,16.3%,2.0%,光滑念珠菌,175,92.0%,8.0%,新型隐球菌,98,92.9%,7.1%,其他酵母菌,175,38.9%,38.3%,17.7%,总计,1243,87.2%,10.0%,2.2%,菌种,33,无名念,15,光滑念,6,克柔念,6,其他,6,表,.,近平滑念珠菌鉴定错误,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,1481,株念珠菌地域性分布差异,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,701,株白色念珠菌药物敏感性,药物,S,SDD/I,R,氟康唑,99.0%,0.3%,0.7%,伏立康唑,98.7%,0.3%,1.0%,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,202,株近平滑念珠菌药物敏感性,药物,S,SDD/I,R,氟康唑,93.6%,0.5%,5.9%,伏立康唑,95.5%,1.0%,3.5%,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,175,株光滑念珠菌药物敏感性,SDD,R,氟康唑,78.3%,21.7%,WT,non-WT,伏立康唑,82.9%,17.1%,Confidential document,only for internal communication,Vfend Brand Team 2014,中国唑类药物敏感性现状,CHIF-NET,1,Feasible Fungal Diagnosis,伏立康唑敏感性变化,Confidential document,only for internal communication,Vfend Brand Team 2014,ICU,念珠菌理性病学调研（,CHINA-SCAN,）,1,Feasible Fungal Diagnosis,在所有,306,位患者中有,224,位患者获得了微生物的结果（由于法规限制，并非所有标本都寄至中心实验室进行确认）,白色念珠菌为最常见致病病原菌,(41.8%),，其次分别为近平滑念珠菌,(23.8%),，热带念珠菌,(17.6%),和光滑念珠菌,(12.3%),致病菌株的分布,药物的敏感性,白色念珠菌,光滑念珠菌,CLSI,取消氟康唑对光滑念珠菌敏感折点，伏立康唑流行病学折点为抑菌圈,16mm,J Antimicrob Chemother doi:10.1093/jac/dkt083,Confidential document,only for internal communication,Vfend Brand Team 2014,ICU,念珠菌理性病学调研（,CHINA-SCAN,）,1,Feasible Fungal Diagnosis,CLSI,取消氟康唑对光滑念珠菌敏感折点，伏立康唑流行病学折点为抑菌圈,16mm,诊断主要来自外周血（,100%,），腹腔渗出液（,16.6%,）和胸腔积液（,6.6%,）,从收集到临床标本到获得阳性结果的间隔的中位时间为,5,天,27.6%,的患者在收集培养标本前开始用药，,61.9%,的患者在获得阳性培养结果的情况下开始抗真菌治疗，,10.4%,的患者在获得其他微生物学证据的情况下开始抗真菌治疗（如：,G,实验，肺泡灌洗液培养阳性等）,初始治疗的药物选择,药物选择的影响因素,氟康唑是最常用的一线治疗药物,Confidential document,only for internal communication,Vfend Brand Team 2014,ICU,念珠菌理性病学调研（,CHINA-SCAN,）,1,Feasible Fungal Diagnosis,在,266,位进行临床治疗评估的患者中,72.6%,的患者获得了临床改善，,35.3%,的患者完全治愈，约,27.4%,的患者无效。,患者的总体死亡率约为,36.6%,，从诊断为,ICI,到患者死亡的中位值为,14.5,天,年龄,实体肿瘤患者,SOFA,评分,呼吸机,表,-,患者死亡影响因素,Confidential document,only for internal communication,Vfend Brand Team 2014,ICU,念珠菌理性病学调研（,CHINA-SCAN 2,）,1,Feasible Fungal Diagnosis,Confidential document,only for internal communication,Vfend Brand Team 2014,ICU,念珠菌理性病学调研（,CHINA-SCAN 2,）,1,Feasible Fungal Diagnosis,白色念珠菌，近平滑念珠菌和热带念珠菌分别为,ICU,最常见分离念珠菌,Confidential document,only for internal communication,Vfend Brand Team 2014,ICU,念珠菌理性病学调研（,CHINA-SCAN 2,）,1,Feasible Fungal Diagnosis,在,244,位患者中分离得的,389,株念珠菌，氟康唑的敏感率为,85.9%,，伏立康唑对所有类型的念珠菌敏感率均,90%.,除光滑念珠菌外卡泊芬净对其他念珠菌均敏感（卡泊芬净对光滑念珠菌的敏感率为,86.0%,（,43/50,）,Confidential document,only for internal communication,Vfend Brand Team 2014,ICU,念珠菌理性病学调研（,CHINA-SCAN 2,）,1,Feasible Fungal Diagnosis,不同抗真菌药物对常见念珠菌敏感性,NA,NA,：无数据,*,：卡泊芬净对光滑念珠菌敏感性为,86%,，,14%,为剂量依赖性铭感,*,*,*,：依据流行病学折点光滑念珠菌中约有,94%,为体外敏感的野生型（,WT,）,Confidential document,only for internal communication,Vfend Brand Team 2014,今年来究竟在卡泊芬净身上发生了些什么？（,2013 TIMM,）,Feasible Fungal Diagnosis,棘白菌素对白色念珠菌及光滑念珠菌耐药趋势,2013 6,th,TIMM,Danmark,David S.Perlin,PhD,1.Alexander,et al.CID 2013,杜克医学中心的,Alexander,教授等人对,2001,年,-2010,年收集的,313,例光滑念珠菌进行了对棘白菌素药物敏感性的测试发现起耐药率呈逐年上升趋势,。,Confidential document,only for internal communication,Vfend Brand Team 2014,今年来究竟在卡泊芬净身上发生了些什么？（,2013 TIMM,）,Feasible Fungal Diagnosis,1.Alexander,et al.CID 2013,病原菌的膜蛋白改变是棘白菌素光滑念珠菌致侵袭性念珠菌病治疗失败的重要因素，临床判断价值优于,MIC,Confidential document,only for internal communication,Vfend Brand Team 2014,今年来究竟在卡泊芬净身上发生了些什么？（,2013 TIMM,）,Feasible Fungal Diagnosis,1.Alexander,et al.CID 2013,CLSI,原有敏感折点,2mg/L,无法有效 的将,FKS,膜体蛋白改变的病原菌从药物的敏感区间中区分出来，,CLSI,对折点进行了调整,Confidential document,only for internal communication,Vfend Brand Team 2014,小结及学习要求,中国念珠菌流行病学研究中近平滑为第二大致病病原菌,关键信息,：,威凡对念珠菌属始终保持,90%,的敏感率,光滑念珠菌靶位（,FKS,膜体蛋白）改变增加棘白菌素临床失败率,学习要求,：,了解,CHIF-NET,病原菌分布和药物敏感性现状,了解,CHINA-SCAN,中从侵袭性念珠菌诊断到死亡的死亡周期,了解棘白菌素对念珠菌的敏感性变迁和潜在机制,Feasible Fungal Diagnosis,