超级细菌流行现状及对策1212.pptVIP

* VRE：万古霉素耐药肠球菌 数据来源上海华山医院抗生素研究所CHINET全国耐药监测 VRE分离率逐年递增 1945年院内感染的20%金黄色葡球菌对其产生抗 性 万古霉素除了拥有广泛的适应症外，还被众多的权威指南推荐为治疗MRS感染的一线用药 最新出炉的《桑福德抗微生物治疗指南》（《热病》）09-10版，推荐万古霉素是MRS感染的首选，而利奈唑胺是备选方案 另外美国，欧洲及亚洲各地的权威指南都推荐万古霉素是治疗MRS感染的首选。 * * * * Herfindaland ET,Gourley DR(2000) Textbook of Therapeutics: Drug and Disease Management. Lippincott Williams and Wilkins, Philadeophia 半衰期变化的原因（1)剂量效应 (2)尿液pH (3)个体差异 (4)年龄 (5)药物相互作用 (6)生理及疾病 * VRE 万古霉素耐药肠球菌；MRSA 甲氧西林耐药金葡菌；VISA 万古霉素中介金葡菌；hVISA 万古霉素异质性耐药金葡菌；CRK 碳青霉烯类抗生素耐药肺炎克雷伯菌；CRAB 碳青霉烯类抗生素鲍曼不动杆菌；PDRAB 全耐药鲍曼不动杆菌；CRPA 碳青霉烯类抗生素铜绿假单胞菌；PDRPA 全耐药铜绿假单胞菌；CRE 碳青霉烯类抗生素耐药肠杆菌科细菌 * * * * * Aside from patient risk factors, there are risk that are associated with the operation itself. You can look at the operative risks as occurring: per-operatively (before the surgery) intra-operatively (during the surgery) post-operatively (after the surgery) The highest risk to the patient is thought to be intra-operatively, or during the procedure, although there are activities before and after the operation that must be considered very risky as well. Some of these things on this list become trade-offs such as surgical drains- although they increase risk, a higher risk would be taken if there was a need for a drain it was not place. Placement of a foreignobject is part of the procedure for valve replacement of hip replacement. However there are some withing this list that are risk factors that we can mitigate or eliminate. Fighting Infection In The First hours 快速检测 如革兰染色 开始经验性治疗 1小时内 根据微生物结果调整治疗 取样 必要时BAL 经验性治疗和目标治疗的统一 留取标本进行微生物学检查 开始经验性抗感染治疗 目标治疗 选择哪种抗菌药物(which antibiotic?) 感染部位的常见病原学(possible pathogens on site of infection) 选择能够覆盖病原体的抗感染药物(antibiotics requirement) -抗菌谱/组织穿透性/耐药性/安全性/费用 考虑药代动力学/药效动力学(PK/PD) 考虑病人生理和病理生理状态( physiologic pathophysiology) 高龄/儿童/孕妇/哺乳(advanced age/children/pregnant women/breast feeding) 肾功能不全/肝功能不全/肝肾功能联合不全(renal/heptic dysfunction/combined) 其它因素(other c