重症患者的感染与抗生素治疗选择--李文华_培训课件.pptVIP

Conclusion To achieve the goal of developing safe and efficacious medicines for patients around the world and of prescribing right drug and right dosage for patients, we need to recognize racial/ethnic diversity in the development of new drugs and in the clinical patients care. Racial Differences in Responses to Pharmacological Treatments usually reflect variation in the distribution of polymorphic traits, which occur at different frequencies in different populations. Some of differences in drug response may not be related to the variation in the distribution is likely to be due to multiple genes and/or multiple environmental factors involving drug metabolism and drug sensitivity. 谢 谢 ！ * 这是抗生素耐药问题的一个图。它显示的是美国细菌耐药的问题。时间阶段要分99年和94－98年两个阶段。纵坐标的上面是耐药的球菌，比如说耐药的肠球菌，耐甲氧西林的金黄色葡萄球菌，他们的耐药率是相当高的。在纵坐标的下面列出了一些阴性杆菌，对三代头孢、亚胺培南、喹诺酮类耐药的杆菌，这个趋势让人非常非常的担忧，也是发展很快的。 我国重症肺炎的标准 The authors of this report identified an important linkbetween processes of care and mortality.Based on these results, hospitals willsoon be required by the Healthcare FinancingAdministration (now renamedthe Centers for Medicare and Medicaid)and the Joint Commission on Accreditationof Healthcare Organizations to document that they treat all cases of community-acquired pneumonia within 8 hrs of arrival to the emergency room (or potentially within an even shorter time All these studies show that modifying an initial inadequate therapy (including no initial antibiotic therapy), according to microbiological results, in severely ill patients with VAP does not translate into a better outcome. This is probably because the time window is too short to change an inappropriate antibiotic therapy regimen soon enough to reduce mortality in patients with VAP. This relates to the controversies in diagnosing VAP, since invasive diagnostic methods are unlikely to impact mortality in VAP patients unless they increase the likelihood of adequate initial therapy, and no study has claimed that these methods are capable of creating su