ICU阳性菌感染规范化治疗技术总结.ppt

因此，Kalil等学者在2013年发表的这篇荟萃分析，得出了与既往多项荟萃分析一致的结论。如Walkey等人在2011年得出随机对照试验不支持利奈唑胺治疗医源性肺炎优于糖肽类抗生素的结论。如Falagas等在2008年得出万古霉素和利奈唑胺在肺炎患者的治疗成功率方面没有差异，如Beibei等人在2010年得出二者在血流感染或肺炎患者的治疗成功率方面没有差异。 所以，对这篇荟萃分析简单总结一下，在死亡率和临床反应率方面，万古霉素和利奈唑胺的有效性差异接近于零；在不同患者人群、设计和质量的研究之间具有一致性；检测出死亡率和临床反应率之间差异的统计学效能将近100%；万古霉素和利奈唑胺治疗HAP/VAP的有效性无统计学差异 Figure 3. Antibiotic treatment algorithm for methicillin-resistant Staphylococcus aureus MRSA nosocomial pneumonia NP . A Consider anti-MRSA treatment if any of the following risk factors are present: MRSA colonization during current admission; history of MRSA infection/colonization; patient previously received broad-spectrum agents against Gram-negatives with no response; MRSA is endemic in the specific hospital unit; positive Gram stain result for Gram-positive cocci in clusters. B This is a conservative value; a series of Monte Carlo simulations found that vancomycin may not be useful for treating serious MRSA infections with minimum inhibitory concentration MIC values 1 mg/L 44 . C Good response at day 3 of antibiotics: CPIS ≤6; increase of PaO2/FiO2; improvement in pulse, temperature, blood pressure and oxygen saturation. Good response at day 5 of antibiotics: clinical pulmonary infection score CPIS ≤6 or a reduction in CPIS ≥2 compared with baseline, or a C-reactive protein ratio of ≤0.4; improvement in pulse, temperature, blood pressure and oxygen saturation. D Poor response: stable but not improving at 5 days. E Be aware of potential myelosuppressive side effects with linezolid treatment longer than 14 days. F Treatment failure: worsening clinical status within 5 days * * 稳可信说明书推荐用药剂量：成人：2g/天，500mg q6h 或 1g q12h 儿童：40mg/kg/天，分2-4次静滴 新生儿：10-15mg/kg 出生1周内，q12h 出生1周到1月，q8h 老年患者剂量减半使用：500 mg q12h 或 1g qd 肾功能损害患者：每天剂量应适当减少 参照稳可信产品说明书 * 肾功能受损的患者，首先可根据《国家抗微生物治疗指南》里面推荐的三档肌酐清除率做相应剂量给药调整 * 2005-2010年在中国为期4年的GPRS细菌耐药监测数据看： 绝大多数菌株的MIC值集中在0.5ug/ml和1ug/ml 08年分布在1ug/ml的菌株45％较07年的80％有所减少，05－08年并未出现MIC的漂移。 Kalil AC, Klompas M, Haynatzki G, e