中文全球MDR细菌感染趋势及治疗策略Kollef终稿_培训课件.ppt

治疗组的出院概率（Kaplan-Meier曲线） * * The influence of the duration of antibiotic therapy on treatment outcome was assessed in a prospective, multicenter, randomized, double-blind trial of 401 patients with ventilator-associated pneumonia (VAP) in 51 intensive care units in France between May 1999 and June 2002 . Patients were randomly assigned to an 8-day or 15-day course of antibiotic therapy. Drug selection was at the discretion of the treating physician but, preferably, the initial empirical regimen combined at least an aminoglycoside or fluoroquinolone and a broad-spectrum β-lactam antimicrobial. Streamlining of the initial regimen based on culture results of bronchoscopic specimens was strongly encouraged. Of the 401 patients evaluated, 197 were assigned to the 8-day regimen and 204 to the 15-day regimen. All patients received appropriate initial empirical antibiotic therapy. Patient outcomes indicated no benefit to prolonging antibiotic therapy from 8 to 15 days. Thirty-seven (19%) patients receiving the 8-day regimen and 35 (17%) treated for 15 days died within 28 days of the onset of VAP. Pulmonary infection recurred in 57 (29%) patients in the 8-day group and 53 (26%) in the 15-day group. Ref 1, Chastre 2003, p 2593, Table 4, R1,5; p 2595, C1, ?2, L1-3 * Ref 1, Chastre, p 2589, C1, ?3, L1,2, C2, ?1, L1, ?2, L1-9, C3, ?2, L1-10; p 2590, C1, ?1, L1-3, ?2, L1-25; p 2592, C3, ?4, L1-8 Ref 1, Chastre, p 2592, C3, ?4, L1-8; p 2593, C1, ?4, L1-4, ?5, L1-4, C2, ?1. L1,2, Table 4, C1-3, L7; p 2595, C1, ?2, L1-10 Reference Chastre J, Wolff M, Fagon J-Y, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290(19):2588-2598. * * 从这个研究中可以看到，深蓝色的柱子是0.5g一次输注，而浅蓝色的柱子是1g一次输注，显然，增大给药剂量可以延长T〉MIC的时间，特别是当MIC较高的耐药菌，提高剂量才能超过T〉MIC为40%的靶目标 * * 头孢他啶MIC与PK/PD指数[%fT??MIC （b）、fAUC/MIC （c）和fCmax/MIC （d）]间的关系和治疗结束时的微生物消灭比率。曲线表示用变量斜率Emax模型的模型拟合。 该幻灯片中显示的CrCl数据强调亚胺培南组中具有CrCl =150的受试者治愈率相对较高，相比之下，其它亚胺培南亚组和多利