4.小儿脓毒症啃鹿菌药物治疗 -刘春峰.ppt

全国基层医疗机构抗菌药物合理应用小儿脓毒症抗菌药物治疗 培训项目;脓毒症（Sepsis）-对人类的挑战;感染的增加趋势;The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003; 167:695–701 ;预计到2050年,美国人口增加约30%,但全身性感染患者数将增加1倍以上;儿童脓毒症;儿童脓毒症; 重症感染的发病过程; ;抗生素的作用-阻断进展;抗生素在脓毒症治疗中的作用;Kreger BE et al. Am J Med 1980;68:332-43. Meehan TP et al. JAMA 1997;278:2080-4. Opal SM et al. Crit Care Med 1997;25:1115-24. Pittet D et al. Am J Respir Crit Care Med 1996;153:684-93. Simon D et al. Crit Care Clin 2000;16:215-31.;适当的抗生素治疗可以降低革兰阴性菌感染的病死率;多项预后指标：挽救生命，缩短住院时间，改善成本效益比;对预后的影响：住院日;对预后的影响：医疗费用;在ICU接受起始不适当治疗的重症感染患者的病死率*;Effect of Antibiotics on Survival from Sepsis acquired in the community ;抗生素在脓毒症治疗中的作用;抗生素治疗需要考虑的因素;Major Risk factors for mortality other than antibiotic treatment in patients with gram-negative bacteremiaa (Leibovici 2004) Risk factor Survivors (n =1,652) Patients who died(n =513) Age (yr)b 60 74 Underlying disorder (% of patients) Antibiotic treatment 33.5 49.3 Steroid treatment 12.1 21.6 Neutropenia 8.6 14.1 Overt malignancy 20.9 32.0 Hospital infection (% of patients) 33.4 54.8 Unknown bacteremia (% of patients)16.8 33.7 Pseudomonas sp. (% of patients) 13.9 22.0 Septic shock (% of patients) 3.2 32.8 a All comparisons are statistically significant (P # 0.0001). b Values are medians.; Independent risk factors for mortality for 136 patients with Pseudomonas aeruginosa bacteremia Risk factor OR (95% CI) P Ineffective definitive antibiotic treatment 11.68 (2.51-54.38 ) 0 .002 Ineffective empirical antibiotic treatment 4.61 (1.18-18.09) 0 .028 Presentation with septic shock 45.37 (10.19-201.93) .001 Pneumonia 11.43 (2.60-50.19) 0.001 Increasing APACHE II scorea 1.31 (1.15-1.50) .001 NOTE.?????Multivariate analysis using logistic regression model.