150.3 🩺 內科專科考前版

150.3.0.1 1️⃣ 22E 新 Antibiotics for MDR

藥	Target
Ceftazidime-avibactam	KPC, OXA-48, AmpC, ESBL, MDR Pseudomonas
Meropenem-vaborbactam	KPC
Imipenem-relebactam	KPC, MDR Pseudomonas
Cefiderocol	All carbapenemases (siderophore Trojan horse) — last-line CRE / Acinetobacter / Stenotroph
Sulbactam-durlobactam	MDR Acinetobacter (FDA 2023)
Ceftolozane-tazobactam	MDR Pseudomonas
Plazomicin	CRE (aminoglycoside, escapes AME)
Eravacycline	MDR GN (intra-abdominal)

150.3.0.2 2️⃣ Resistance Surveillance

• NHSN (US CDC): national HAI / resistance database
• WHO GLASS (Global Antimicrobial Resistance Surveillance System)
• Taiwan CDC: CRE / VRE / MRSA / MDR-TB national tracking
• ESBL community-acquired rates by country (Taiwan ~ 15-30% E. coli)

150.3.0.3 3️⃣ Stewardship Bundles

• 2024 IDSA/SHEA Implementation Guide
• PCT-guided discontinuation (multiple RCTs)
• Short courses (5-7 day instead of 10-14) for many infections
• POET, OVIVA, STOP-IT paradigm shifts

150.3.0.4 4️⃣ 台灣 context

• CRE prevalence rising — IMP-positive K. pneumoniae endemic
• NDM imported from India/South Asia
• ESBL community: ~ 15-30% E. coli (high in Asia)
• N. gonorrhoeae: ceftriaxone-resistant rare but emerging
• MDR-TB: 約 1-2% in Taiwan
• 健保 anti-MDR (CAZ-AVI, cefiderocol, sulbactam-durlo) restricted — ID consult mandatory

150.3.0.5 5️⃣ Future Therapies

• Phage therapy (compassionate use): MDR / failed antibiotic
• CRISPR-Cas9 antimicrobials: target specific resistance genes
• Anti-virulence (anti-toxin) Abs: bezlotoxumab (CDI), Aurigene (S. aureus)
• Microbiome modulation: FMT, defined consortia, prebiotics
• AI-driven drug discovery: 2020 halicin discovery (DL model)

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