脓毒症的新认识与治疗分析报告.ppt

结束语 人类对脓毒症的认识还很不完善。 到目前为止还没有一种药物能在临床上满意应用。 脓毒症必须早期确诊，有效治疗。 谢谢大家 * Development of High Prevalence of Resistance in Clinically Important Pathogens Methicillin-resistant staphylococci: 1. Vancomycin has become the drug of choice for treating MRSA infections1 2. Reports of strains of MRSA with intermediate resistance to glycopeptides may signify the development of strains with higher levels of resistance to vancomycin.1-3 GISA strains are generally associated with previous MRSA infections, repeated, prolonged use of vancomycin, and dialysis therapy2 Vancomycin-resistant enterococci: 1. Vancomycin-resistant enterococci accounted for nearly 25% of enterococci isolated from ICU patients and 15% of cases isolated from non-ICU patients in 1997 in the United States4 2. The increased use of vancomycin for resistant infections helps select for VRE.5 Vancomycin resistance is carried on a plasmid and can potentially spread beyond enterococci to staphylococci and streptococci6,7 The Centers for Disease Control and Prevention (CDC) reported the first case of VRSA infection in July 20028; the second case was reported in October 2002.9 Although unrelated, both isolates contained the mecA and vanA genes, mediating oxacillin and vancomycin resistance, respectively8,9 According to the CDC, “the presence of vanA in this VRSA suggests that the resistance determinate was acquired from a vancomycin-resistant enterococcus”9 References: 1. Jones RN, Low DE, Pfaller MA. Epidemiologic trends in nosocomial and community-acquired infections due to antibiotic-resistant gram-positive bacteria: the role of streptogramins and other newer compounds. Diagn Microbiol Infect Dis. 1999;33:101-112. 2. Smith TL, Pearson ML, Wilcox KR, et al. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-intermediate Staphylococcus aureus working group. N Engl J Med. 1999;18:340:493-501. 3. Hiramatsu K, Hanaki H, Ino T, et al. Methicillin-resistant Staphylococcus aureus clinical s