Введение в антимикробную терапию (д.м.н., проф. И.А.Карпов)

реклама
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,
.
•
•
,
,
, 50, 9
”
1930
1940
1950
1960
1970
1980
1990
2000
2002 Glycilcyclines
1999 Oxazolidinones
1962 Quinolones
1962 Streptogramins
1958 Glycopeptides
1952 Macrolides
1950 Aminoglycosides
1949 Chloramphenicol
1949 Tetracyclines
1940 Beta-lactams
1936 Sulfonamides
,
,
.
.
.
,
,
:
Vira -
;
Eucariotae -
;
Procariotae ,
,
,
,
.
,
.
,
,
,
(
,
.
,
,
,
:
);
(
);
;
)
-
,
.
,
,
,
,
-
"
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,
,
"
,
,
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,
,
.
,
,
-
.
.
).
-
)
(
-
,
,
.
-
.
(
,
.
.
,
.
,
.
—
,
.
:
,
20
,
,
.
Gracillicutes [
. gracilis,
flrmus,
cutis,
, + cutis,
, + cutis,
] —
,
+
] —
; Tenericutes [
]—
; firmicutes [
. tener,
Mollicutes) Mendosicutes [
cutis,
] —
).
—
.
,
,+
. mendosus,
,
1
.
Leptospira.
2
.
;
Treponema, Borrelia
.
.
Campylobacter, Helicobacters Spirillum.
3
)
.
.
.
(
4
Pseudomonada-
.
,
.
Legionellaceae, Neisseriaceae
-
Acinetobacter, Afipia, Alcaligenes,
Bordetella, Brucella, Flavobacterium, Francisella, Kingella Moraxella.
5
.
.
— Enterobacteriaceae, Vibrionaceae Pasteurellaceae,
,
Calymmobaterium, Cardiobacterium,
Eikenetta, Gardnerella Streptobacillus.
6
,
Porphoromonas Prevotelta.
.
-
.
Bacteroides, Fusobacterium,
7
.
,
8
.
po
12
,
.
Veillonella.
9
.
Rickettsiaceae, Bartonellaceae Chlamydia
.
10 11
.
.
,
—
.
.
.
,
.
13 14
.
15 16
,
17
,
;
,
.
.
Enterococcus
Leuconostoc, Peptococcus, Peptostreptococcus, Sarcina,
Staphylococcus, Stomatococcus, Streptococcus.
.
.
18
.
19
.
.
Clostridium Bacillus.
Erysipelothrix Listeria.
20
.
Corynebacterium Gardnerella, Mobiluncus
.
-
.
.
,
Actinomyces,
20
.
.
Actinomyces, Corynebacterium Gardnerella,
Mobiluncus
.
21
.
Mycobacterium,
.
.
.
22-29.
(
22)
Gordona, Nocardia, Rhodococcus, Tsukamurella, Jonesia,
Oerskovi Terrabacter
.
30
.
,
Acholeplasma, Mycoplasma Ureaplasma.
.
(31),
(32
,
.
(35) —
(34),
,
(33),
1.
2.
3.
4.
5.
–
–
,
,
–
S. pyogenes
H.influenzae
*
<5
.
: 3-5%
:
Meningite
Epiglottite
Batteriemia
Cellulite
Artrite settica
Polmonite, Empiema
: : 50-80%
.
:
Otite media
Congiuntivite
Sinusite
Bronchite
* 6 tipi a-f (tipo B = 95%)
E.coli
•
50%
,
•
30%
,
–
…
SCOPPE,
•
,
•
19%,
64%.
EPIC
29%,
,
,
30%
19%,
8%, Acinetobacter 9%,
10617
,
12%,
18%.
,
•
,
,
,
•
•
• cinetobacter,
•
•
•
,
,
,
.
.
41
Pyogenic streptococci
S.aureus
Gram(-)
MRSA
Enterococci
CNS
Candida sp.
1920
30
40
50
60
70
80
90
2000
1.
,
2.
(
)
3.
4.
5.
,
.
6.
7.
«
).
(
,
»
–
,
1.
–
2.
–
–
1.
2.
,
)
3.
4.
–
)
1.
(
,
)
2.
3.
4.
–
1.
2.
3.
4.
,
.
,
–
,
!
PEARLS (2001–2002 .)
–
RESORT (2001-2003
3,2%
59,4%
2,6%
2,0%
10,1%
3,4%
,%
5,2%
15,5%
4,9%
13,0%
7,7%
14,3%
27,4%
15,0%
59,4
27,4
13,0-15,5
10,1
4,9-7,7
3,2-3,4
2,0-2,6
.)
,
(
,
).
.
,
»
–
–
Enterococci
•
.
•
.
1.
(
)
2.
3.
4.
«
»
–
,
•
,
.
.
•
,
35%.
•
•
.
,
.
8-
,
,
,
.
•
.
2-92
-
.
,
1000
2-12
.
4-51
:
,
.
50% ,
"
Stuart Levy
IDCP, August 1998
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