应对耐药菌选择抗感染药物策略-培训课件.pptVIP

除了左氧氟沙星和大环内酯类，三代头孢也是重要的危险因素。这张幻灯片显示的是一项在英国进行的为期5年的研究，总结了MRSA感染的发生和左氧氟沙星、大环内酯类、三代头孢的关系。抗生素的使用和MRSA的感染有一个“滞后效应”，即MRSA感染一般发生于抗生素使用后几周或几个月。研究者在充分考虑到这一“滞后效应”后，对三类抗生素和MRSA感染的关系进行了总结，结果如图所示，三类抗生素的总处方量和MRSA感染的发生率有着很好的吻合性，提示抗生素治疗有可能驱动MRSA感染发生率的上升。 * Importance of Initial, Appropriate Antibiotic Therapy Study objective: To evaluate the relationship between inadequate antimicrobial treatment of infections (both community-acquired and nosocomial infections) and hospital mortality for patients requiring ICU admission1 Study design: Prospective cohort study at a Missouri hospital, July 1997 through March 19981 The 169 patients who initially received inadequate antimicrobial therapy for infection represented 26% of the 655 patients assessed to have either community-acquired or nosocomial infections1 All-cause mortality was 52% in patients receiving inadequate antimicrobial therapy versus 24% in those receiving adequate therapy (P.001)1 Infection-related mortality was 42% in patients receiving inadequate therapy versus 18% in those receiving adequate therapy1 Risk factors for mortality included prior antibiotic therapy (odds ratio [OR]=3.39) and bloodstream infection (OR=1.88) (data not shown on slide)1 Reference 1. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999;115:462-474. * Oxazolidinedione Linezolid (Zyvox?) Streptogramins Quinupristin/dalfopristin (Synercid?) Pristinamycin (not yet A/V) Second generation glycopeptides Dalbavancin (Zeven?) Oritavancin (not yet A/V) Cyclic lipoglycopeptide Daptomycin (Cubicin?) Ketolide Telithromycin (Ketek?) Glycylcycline Tigecycline (Tygacil?) Polymixins Colistin (Colomycin?) * 根据CHINET 2005年报告，大肠埃希菌的ESBLs检出率为38.9% 4，C，而根据CHINET 2006年报告，大肠埃希菌的ESBLs检出率为51.7% 5，D。 研究设计： C. 中国8所教学医院组成的CHINET耐药监测网，2005年1月1日至12月31日共收集22774株临床分离株，其中革兰阳性菌7530株，革兰阴性菌15244株。按统一方案、统一方法(Kirby-Bauer法）和判断标准(CLSI 2005版）进行细菌耐药性监测。 D. 中国9所教学医院组成的CHI