ICU抗感染策略—培训课件.pptVIP

杭州 * * * * * Schwaber et al performed a meta-analysis including 16 studies that evaluated outcomes associated with bacteremia due to ESBL-producing versus non–ESBL-producing Enterobacteriaceae.1 ESBL producers were associated with a significant increase in mortality (RR 1.85, 95%CI 1.39–2.47, P .001) and a delay to the initiation of effective therapy (RR 5.56, 95%CI 2.94–10.51, P .001). In a previous retrospective cohort study of patients with bacteremia due to Escherichia coli, Klebsiella spp., or Proteus spp.,2 Schwaber et al compared 99 cases (infection with ESBL producer) with 99 controls (infection with non-ESBL producer). In addition to an association with increased mortality (OR 3.6, P = .008) and delays to the initiation of effective therapy (OR 25.1, P .001), ESBL production was independently associated with increased LOS following the positive blood culture (OR 1.56, P = .001) and increased hospital costs (OR 1.57, P = .003). References: 1. Schwaber MJ, et al. J Antimicrob Chemother. 2007;60:913-920. 2. Schwaber MJ, et al. Antimicrob Agents Chemother. 2006;50:1257-1262. The relationship between inadequate antibiotic therapy and hospital mortality was examined in a prospective cohort study of 655 critically ill adult patients with clinically recognized infections at a university-affiliated urban teaching hospital in St. Louis from July 1997 through March 1998. The study population included both patients with community-acquired infections that required intensive care unit (ICU) admission and patients with nosocomial infections acquired in the ICU. Of the 655 patients, 169 (25.8%) initially received inadequate antimicrobial therapy, defined as a positive culture result for a pathogen not being effectively treated at the time of its identification. Overall hospital mortality in this group was 52% compared with 24% in 486 patients who received adequate antimicrobial treatment (P.001). Infection-related mortality was also significantly higher (P.001) in pa