经验性抗感染治疗课件课件.ppt

*Infectiousdiseasesspecialistsareoneimportantresourceforprovidinginput,butmanyotherprofessionalsalsocontributetooptimalcareforpatientswithinfectionsLikeallpatientsafetyendeavors,multidisciplinarycollaborationiskey!InaunivariateanalysisofacomparisonofthemeanvaluesofthegroupwithaPRPAVAPandthegroupwithaPSPAVAP:Priorantimicrobialtherapywithimipenem(P=.04)orafluoroquinolone(P=.007)wasassociatedwithpiperacillin-resistantPaeruginosaventilator-associatedpneumonia.ThiswasinadditiontomoredifferentclassesofantibioticsadministeredbeforeVAP(P=.01[Datanotshown]).Athird-generationcephalosporinhadbeenprescribedmorefrequentlytothePRPAgroup,butthedifferencebetweenthe2groupsdidnotreachstatisticalsignificance. Theanalysiswasconducted,andthischartwasorganizedaccordingtotheantibioticclassofantimicrobialtherapythathadbeenprescribedduringthe15daysprecedingthediagnosisofVAPusingfiberopticbronchoscopy.*Theintroductionofeverynewclassofantimicrobialagentsisfollowedbyemergenceofresistance.By1962,penicillin-resistantS.aureuswereamajorthreatinhospitalsandnurseries.Bythe1970s,methicillin-resistantS.aureushademergedandspread,aphenomenonthatencouragedwidespreaduseofvancomycin.Inthe1990s,vancomycin-resistantenterococciemergedandrapidlyspread;mostoftheseorganismsareresistanttoothertraditionalfirst-lineantimicrobialdrugs.In1997,thefirstS.aureusstrainswithreducedsusceptibilitytovancomycinweredocumented,promptingconcernsthatS.aureusfullyresistanttovancomycinmaybeonthehorizon.InJune2002,thefirstcaseofvancomycin-resistantS.aureuswasdetected;thepatientwasreceivingchronichemodialysis.*哺乳期患者抗菌药物的应用药物可自乳汁分泌，无论乳汁中药物浓度如何，均存在对乳儿潜在的影响，并可能出现不良反应哺乳期应用任何抗菌药物时，均宜暂停哺乳乳汁中含量较高喹诺酮、四环素类、大环内酯类、氯霉素、磺胺、甲氧苄啶、甲硝唑、异菸肼、乳汁含量较低青霉素类、头孢菌素类、氨基糖苷类第63页，