医院获得性感染与抗生素合理应用.PPTVIP

医院获得性感染与 抗生素合理应用Hospital－Acquired Infection and Reasonable Application Of Antibiotics 东南大学医学院急诊与危重病医学教研室 东南大学附属中大医院ICU 黄英姿 定义 Definition 院内感染为患者住院期间获得的感染，入院时既不存在，也不处于潜伏期。48~72h Hospital－Acquired Infection means infection acquired when patients stay in hospital ，i.e. when patients arrived hospital ,they neither exist the infection nor in incubation period. 院内感染的种类 Category 血行性感染 Infection through blood 下呼吸道感染 Lower respiratory infection 外科伤口感染 Infection of surgical wounds 泌尿系感染 Urinary system infection 院内感染的常见致病菌 Common Pathogenic Bacterium G+ 球菌(MRSA、MRSE)明显增多 G+ coccobacteria (MRSA MRSE) increases 真菌明显增多 Eumycete obviously increases G-比例明显下降 G- bacillus obviously decreases 多重耐药细菌比例增多 Multidrug resistant bacteria increases G-杆菌 G- bacillus G+球菌 G+ coccobacteria 真菌 Eumycete 院内感染的危险因素 Risk Factors 使用抗生素 Antibiotics 机械通气 Mechanical ventilation 留置肺动脉导管或中心静脉导管 PAC or CVC salvage 应激性溃疡的预防治疗 Preventive treatment of stress ulcer 留置尿管 Urinary canal salvage 使用皮质激素 Apply corticosteroids 营养状况 Nutritional status ICU住院时间 Length of stay in ICU 治疗 Treatment ● 非抗生素治疗策略 Treatment without antibiotics ● 合理使用抗生素 Reasonable application of  antibiotics ● 免疫调节 Immunological regulation 非抗生素治疗策略 Treatment without antibiotics  ●引流 Drainage ●体位 Body position ●手部清洁 Hands depuratory  ●穿隔离衣、带手套 Wearing isolative gown and gloves  ●洗必太漱口  Gargling with chorhexidine 感染灶的充分引流Sufficiently Drain 抗生素合理使用 Reasonable Application Of Antibiotics  ●预防性应用 Prophylatic application  ●治疗性应用 Remedial application 预防性应用抗生素Prophylatic application of antibiotics ●概念 Definition  ●目的 Purpose  ●适应证 Indication 预防性应用抗生素Prophylatic application of antibiotics  ●给药方法 Medication  ●疗程 Course of treatment 经验性抗生素应用 Experiencing application of antibiotics ●概念 Definition