抗菌药物使用强度心脏介入抗菌药物使用.ppt

* * 一般来说，应在手术开始前0.5?2 h开始给药，保证在发生污染前血清及组织中药物已达到有效浓度（MIC90） 术前介入诊断与介入治疗不好判定时，术中给药视为合理 The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection * Classen DC, et al.. N Engl J Med 1992;326:281 Incision Hours before incision Hours after incision Antibiotic Administered Importance of Timing of Surgical Antimicrobial Prophylaxis Time of Administration No. of patients No. (%) of infections Odds ratio Early (2–24 hours before incision) 369 14 (3.8) 4.3* Preoperative (0–2 hours before incision) 1,708 10 (0.59) NA Perioperative (≤3 hours after incision) 282 4 (1.4) 2.1? Postoperative (3 hours after the incision, but 24 hours after surgery) 488 16 (3.3) 5.8? * P= 0.001. ? P=0.23. ? P=0.0001. NA = not applicable. Classen DC et al. N Engl J Med. 1992;326:281–286. * * 静脉给药，20?30 min滴完 追加：常用?-内酰胺类抗生素半衰期为1?2 h，若手术超过３h，或失血量1500ml，应术中给第２个剂量，必要时还可用第３次 时间较长的手术，宜选择长半衰期药物如头孢曲松 Single- vs Multiple-Dose Surgical Prophylaxis: Systematic Review （28 prospective studies ） McDonald M et al. Aust NZ J Surg. 1998;68:388–396. Adapted with permission from Blackwell Synergy ? 1998. All studies, fixed All studies, random Multi 24h Multi 24h Favors single dose Favors multiple dose Impact of Prolonged Antibiotic Prophylaxis 2,641 patients undergoing CABG Group 1 48 hours of antibiotics Group 2 48 hours of antibiotics SSI rates Group 1 9% (131/1,502) Group 2 9% (100/1,139) Odds ratio 1.0 (95% CI: 0.8–1.3) Increased antibiotic resistant pathogens – Group 2 CABG = coronary artery bypass grafting; CI = confidence interval. Harbarth S et al. Circulation. 2000;101:2916–2921. Treating 48hrs: More resistant bugs Higher cost * * 清洁手术预防用药时间不宜超过24h 手术时间较短(2h)的清洁手术，术前用药一次即可 心脏介入治疗手术参考清洁手术用药，预防用药时间不宜超过24h 仅限辉瑞内部使用 给药途径：P指胃肠外给药，O指口服给药。 * 具体到每一个药物，如何计算DDD数。 * 控制抗菌药物使用强度，应该着眼于医院的全局，立足于合理使用抗菌药物的基本原则。 * 选择抗感染治疗方案，必须遵循抗感染治疗的基本原则，首先考虑控制感染，而不是控制DDD数。 * 减少使用抗菌药物的人数。 * In clean surgical procedures in which the GI tract has not been entered, Staphylococcus aureus is the