(精选)Appropriate Antibiotics use in CAP and Non-CAP patients at SOCH ...教学课件.pptVIP

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(精选)Appropriate Antibiotics use in CAP and Non-CAP patients at SOCH ...教学课件.ppt

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Respiratory Pathogens in CAP1 Similar to acute bacterial sinusitis and AECB, S pneumoniae is the most common pathogen associated with community-acquired pneumonia, accounting for as many as 60% of all community-acquired pneumonia cases. Other typical pathogens include H influenzae and Staphylococcus aureus. While atypical pathogens like C pneumoniae, M pneumoniae, and Legionella spp are less common, they are increasingly being recognized as important drivers of morbidity in RTIs. Treatment strategies for all RTIs are becoming increasingly complicated by the emergence of S pneumoniae strains resistant to current antibiotic regimens—most notably penicillins and macrolides—which may lead to substantial clinical adverse outcomes. 1. Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med. 1995;333:1618–1624. Fortunately, appropriate antimicrobial therapy significantly improves outcome in patients with nosocomial pneumonia. Several clinical trials have established that inadequate antimicrobial therapy for nosocomial pneumonia can more than double mortality when compared to adequate therapy. This study wished to define the impact of BAL results on the selection of antibiotics and the outcomes of patients with VAP. One hundred and seven patients received antibiotics prior to bronchoscopy and 25 immediately after bronchoscopy (but prior to the results). 65 patients were BAL-positive and 67 BAL-negative. For the BAL-positive patients, if adequate therapy was initiated, a mortality rate of 38% was seen, while inadequate therapy resulted in 91% mortality, and no therapy resulted in 60% mortality. When therapy changes were made after bronchoscopy, more patients received appropriate therapy, but the mortality rate was similar to the rate seen with patients continuing to receive inadequate therapy. And when BAL results became available, 37 of the 42 surviving patients received adequate therapy, but their mortality was comparable to patients who continued to receiv