细菌耐药与抗菌药物合理应用307医院概论.ppt

* * * 要点：对大环内酯耐药的肺炎链球菌在世界各地都很严重，亚洲地区已超过70% 见幻灯 IMP 0.3%；LVX 2008 71.2%， 2010 58.3%； * * * * 要点： 上图为抗生素PK/PD重要的参考数据，评价抗菌药物的临床疗效将根据其药物特点参考以上部分参数，如浓度依赖性抗菌药物参考Cmax/MIC和AUC/MIC。 药代动力学相关的参数包括血浆浓度-时间曲线中的曲线下面积（AUC）、血浆中药物的峰浓度（Cmax）、药物血浆浓度高于MIC（最低抑菌浓度）的时间比例（TMIC）。 药效动力学相关的参数包括MIC、杀菌效应作用的时间（包括PAE） * 50% for %TMIC of a -lactam, 100 for an AUC24/MIC ratio of a fluoroquinolone, or 10 for a Cmax/MIC ratio of an aminoglycoside. * 要点： 药物浓度在该范围内时： 抗生素敏感菌株被抑制 不能抑制发生第一步突变的菌株 耐药菌株亚群选择性增殖 * Is this only in Japan? * and in the world. * * In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care. A mean of 56% of body sites and 17% of environmental sites were VRE positive. After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE. After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated. The inanimate environment plays a role in facilitating transmission of organisms. * This iceberg graphically represents colonization versus infection. Those patients that are infected with an organism represent just the “tip of the iceberg” of patients that are colonized or infected. Just because a patient is not infected, or showing signs of infection, does not mean that they do not carry organisms that could be transferred to another patient if proper hand hygiene and other infection control precautions are not taken. * * * The biggest thing I hope we have communicated today is that biofilms play a major role in the pathology of chronic wounds. The slough, that harmless little bunny that is felt to be a nuisance, is not a nuisance – it is the problem – a painful, deadly problem. And that is the biofilm surprise. That there is organized bacteria biofilm, which looks like an innocuous slime yet it can totally destroy our immune response much like this bunny destroyed the wolf. The surprise for wound care was to find that t