抗生素英文课件精品 Antibiotics Making the right案例实例.pptVIP

Antibiotics: Making the right choice Dr. Christian T. Felter Senior Medical Adviser Wyeth UK Improved Patient Outcomes Associated with Proper Hand Hygiene Ignaz Philipp Semmelweis (1818-1865) Chlorinated Lime Hand Antisepsis Adapted from CDC. Prevent Antimicrobial Resistance: A Campaign for Clinicians. April 2002. The Importance of Initial Empiric Antibiotic Selection Alvarez-Lerma F. Intensive Care Med. 1996;22:387-394. Rello J, et al. Am J Respir Crit Care Med. 1997;156:196-200. Luna CM, et al. Chest. 1997;111:676-685. Kollef MH, Ward S. Chest 1998;113:412-420. Sanchez-Nieto JM, et al. Am J Respir Crit Care Med. 1998;157:371-376. Ruiz M, et al. Am J Respir Crit Care Med. 2000;162:119-125. Dupont H, et al. Intensive Care Med. 2001;27:355-362. P=NS P=NS P=NS P=NS P0.001 P0.001 P=0.06 % Mortality Evolution of Antimicrobial Resistancein Gram-positive Cocci S. aureus Penicillin [1940s] Penicillin-resistant S. aureus Methicillin [1960s] Methicillin-resistant S. aureus (MRSA) Vancomycin-resistant enterococcus (VRE) Vancomycin [1997] Vancomycin (glycopeptide) intermediate-resistant S. aureus Vancomycin- resistant S. aureus Ciprofloxacin 1987 [2002] Ignaz Philipp Semmelweis (1818-1865), a Hungarian obstetrician, postulated his theory on antiseptic hand hygiene techniques in 1847. Semmelweis noted that post-partum women examined by medical students who did not wash their hands after performing autopsies had high mortality rates. He required students to clean their hands with chlorinated lime before examining patients. Maternal mortality declined from 18% to 1% after this hand hygiene intervention was implemented. Studies have consistently demonstrated that the mortality rate was greater in patients with VAP who initially received an inadequate regimen of antibiotics. Changing antibiotics AFTER culture results may be too late This slide shows the historical sequence of resistance development in S. aureus. Shortly after the introduction of penicillin in 1