Equal to the definition of PDR by Falagas
Paterson DL, CID 2007; 45: 1179
常见糖非发酵菌 Non-fermenters
假单胞菌属
铜绿假单胞菌 Pseudomonas aeruginosa
不动杆菌属
鲍曼不动杆菌 Acinetobacter baumannii
Definitions of MDR, XDR, PDR by Falagas
Definitions of PDR, XDR and MDR: 多重耐药 MDR (multidrug resistance): resistance ≥3 classes of antimicrobials 极度耐药 XDR (extensive drug resistance): resistance to all but 1 or 2 泛耐药 PDR (pandrug resistance): resistance to ALL
XDR is used for both Mycobacterium tuberculosis and common bacteria
The rapid increasing of bacterial resistance changes the definition such as MDR
Controversy of definitions between Paterson and Falagas in CID
Why PDR defined as resistant to all antimicrobials? The prefix “pan-” means “all” or “whole” Semantically, “extreme” (first used in the field of oncology/hematology) cannot be more inclusive than “pan-”
Quinolones: Ciprofloxacin, Levofloxacin
plus to:
Ticarcillin-clavulanate, Ampicillin-sulbactam Aminoglycosides including amikacin Tigecycline Polymyxins (colistin and polymyxin B)
There is no organization or association responsible for giving the definitions
Different definitions of PDR are made by different professional persons
23
革兰阴性菌中40％（12337/31002）为糖非发酵菌
（脑膜败血金黄杆菌 Chryseobacterium meningosepticum ）
Percentage (%)
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
多重耐药鲍曼不动杆菌感染的治疗
OUTLINE
不动杆菌在临床分离菌中的比例 不动杆菌的耐药性问题 不动杆菌感染的抗菌治疗
Confusion of MDR, XDR, PDR definitions
The definitions of MDR, XDR, PDR are somewhat confusing:
Extreme Drug Resistance (XDR) for common GNB3
1. MMWR Morb Mortal Wkly Rep 2006; 55: 301
2. Falagas M, CID 2008; 46: 1121
3. Paterson DL, CID 2007; 45: 1179
窄食单胞菌属
嗜麦芽窄食单胞菌Stenotrophomonas maltophilia
产碱杆菌属
粪产碱杆菌 Alcaligenes faecalis
伯克霍尔德菌属
洋葱伯克霍尔德菌 Burkholderia cepacia
黄杆菌属(金黄杆菌属)
脑膜败血黄杆菌 Flavobacterium meningosepticum
38 36 34 32 30 28 26 24 22 20
Year
上海地区糖非发酵菌 在革兰阴性杆菌比例的上升趋势
(Wang F, et al. Int J Antimicrob Agents 2003; 22: 444)
37
36
35 35
35
34 34
34
34
33
33
32
30 30
28
26 26 25
Falagas M, CID 2008; 46: 1121
Definition of XDR (Extreme Drug resistance) for GNB by Paterson
Lacking susceptibility to:
β-lactams: Cefepime, Ceftazidime, Imipenem, Meropenem, Piperacillin/tazobactam
Paterson D, CID 20difference of “X” in XDR
Extensive Drug Resistance (Extensively drug-resistant) (XDR) for M. tuberculosis1 and common gramnegative bacilli2
Alfa Institute of Biomedical Sciences, Greece Tufts Univ. MA, USA
Univ.of Queensland Centre for Clinical Research, Australia
Falagas M, CID 2008; 46: 1121