(精选)Choosing Antibiotics教学课件.pptVIP

Choosing Antibiotics: Before and After the Culture Results;Prophylaxis;Antibiotic selection;Just to refresh your memory…;Cephalosporins*;Case 1;As expected;Vancomycin;Dosing;Monitoring;What if a person can’t “tolerate” Vanco?;Daptomycin;Dosing;Toxicity;Microbiologic Failure;What if the patient grew MSSA?;S. aureus: its own lecture;Another refresher …;B-lactam/B-lactamase inhibitors;Case 2;Case 2;Case 2;Enterococcus species;VRE;Linezolid;Dosing;Toxicity;Serotonin Syndrome;Boyer E and Shannon M. N Engl J Med 2005;352:1112-1120;Linezolid resistance;Linezolid- pneumonia;Case 3;Case 3;Previous culture data; URINE CULTURE 01/02/10 100,000 CFU/mL GRAM NEGATIVE BACILLI Isolate 01 Klebsiella pneumoniae, an ESBL producer CONTACT PRECAUTIONS ANTIBIOTICS Mic SYSTEMIC URINE Aztreonam 16 R Ceftriaxone 8 R* Ceftazidime 16 R Cefotaxime 8 R Cefazolin 16 R* Cefepime 8 R* Ampicillin 16 R* Cefuroxime 16 R* Tetracycline 4 S Ertapenem 2 S Gentamicin 4 S Imipenem 4 S Levofloxacin 2 S Trimethoprim/Sulf2/38 S ;Any changes?;ESBL;Carbapenems;Carbapenems; BLOOD CULTURE 08/02/10 GRAM NEGATIVE BACILLI IN AEROBIC BOTTLE AFTER 13 HOURS Isolate 01 Klebsiella pneumoniae, an ESBL producer ANTIBIOTICS Mic SYSTEMIC URINE Aztreonam 16 R Ceftriaxone 8 R* Ceftazidime 16 R Cefotaxime 8 R Cefazolin 16 R* Cefepime 8 R* Ampicillin 16 R* Cefuroxime 16 R* Tetracycline 4 S Ertapenem 2 S Gentamicin 4 S Imipenem 4 S Levofloxacin 2 R Trimethoprim/Sulf2/38 S ;If you ever see this…;BLOOD CULTURE 07/02/10 GRAM NEGATIVE BACILLI IN BOTH BOTTLES AFTER 7 HOURS. Isolate 01 Klebsiella pneumoniae 07/04/10 - This Organism Is Producing a KPC-type Carbapenemase. All Beta-Lactam Antibiotics Should Be Interpreted As Resistant. Susceptibility testing results for Polymyxin B may be used to predict the activity of Colistin (Polymyxin E). - CONTACT PRECAUTIONS ANTIBIOTICS MIC SYSTEMIC URINE Amox/Clavulanate 16