外科危重病人的抗菌药物治疗（Antimicrobial therapy in critically ill surgical patients）.docVIP

外科危重病人的抗菌药物治疗（Antimicrobial therapy in critically ill surgical patients） Learning goal: 1. identify the most likely pathogens of severe surgical infections 2., according to the antibacterial spectrum of antibiotics and the current drug resistance of bacteria, choose good antibacterial drugs and use them correctly 3. to master the techniques of observation, adjustment and drug withdrawal in the treatment of sepsis I. common pathogens of infection and sepsis According to the statistics of Chinas 8 provinces, municipalities and autonomous regions in 58 hospitals of 40379 strains of bacteria National Center for surveillance of antimicrobial resistance of pathogenic bacteria infection from 2002, were cultivated, the most common is Staphylococcus (20%), Escherichia coli (14.2%), Pseudomonas aeruginosa (accounted for 10.3%), the three together accounted for 45%. Other common cases were Klebsiella pneumoniae (8.2%), Enterococcus (5.4%), Acinetobacter (5.1%) and Enterobacter (4.5%). Gram negative (G-) bacilli remained predominant (63.5%), and gram positive (G+) cocci accounted for 36.5%. The pathogenic bacteria caused by different causes, different kinds and even different parts of infection are different. Table 1 lists the pathogenic characteristics of various kinds of surgical critical infections. Table 1 common pathogens of surgical critical infection Infection type pathogenic bacteria Carbuncle, abscess, cellulitis Staphylococcus aureus Necrotizing fasciitis A variety of bacteria: Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae (Streptococcus pneumoniae), Clostridium G-, Clostridium difficile Erysipelas Streptococcus pyogenes Burn wound infection Staphylococcus aureus, Pseudomonas aeruginosa, enterobacter, Staphylococcus epidermidis, Enterococcus, Escherichia coli, Infection of soft tissue after trauma A variety of bacteria: Staphylococcus aureus, Streptococcus pyogenes (A), Streptococcus pneumoniae, Enterobacteriaceae, Pseudomonas aeruginosa Toxi