抗生素英文课件精品—— Comparison of 8 vs 15 Days of Antibiotics Therapy for Ventilator-Associated Pneumonia in adult讲解说明.pptVIP

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抗生素英文课件精品—— Comparison of 8 vs 15 Days of Antibiotics Therapy for Ventilator-Associated Pneumonia in adult讲解说明.ppt

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Comparison of 8 vs 15 Days of Antibiotics Therapy for Ventilator-Associated Pneumonia in adultJAMA, November 19, 2003 Vol.290, No. 19 R2 曾政森加護病房 July 2005 Introduction Hospitals and particularly ICUs and rapid dissemination of multiresistant bacteria. Nosocomial pneumonia in patients requiring ventilator represents one of the principle reasons for the prescription of antibiotics in ICU. The optimal duration of antibiotic Tx. for VAP ? Shortening the duration of antibiotics Tx. ? Patient’s prognosis ? Risk of relapse ? Objective To determine whether 8 days is as effective as 15 days of antibiotic treatment of patients with microbiologically proven VAP ! Study design and organization Randomized, double-blind trial on 2 parallel groups in 51 ICUs in France (May 1999 ~ June 2002) Antibiotics treatment Drug selection was left to the discretion of the treating physicians. At least an aminoglycoside or a fluoroquinolone and a broad-spectrum betalactam antimicrobial agent Convert this initial regimen into a narrow spectrum therapy based on culture results Follow-up and definition BT, WBC, PaO2/FiO2, tracheal secretions, ventilator status, vital signs and ODIN score ? daily F/U SOFA and CXR on day 3,7,14,21 and 28 Bronchoscope was performed before the introduction of any new antibiotics. Definition of recurrence, relapse, multiresistant bacteria, number of antibiotics-free day, ventilator-free day, organ failure-free day * ODIN: Organ Dysfunction and/or Infection score * SOFA: Sepsis-related Organ Failure Assessment score Recurrence : at least 1 bacterial species grew at a significant concentration from samples collected during a second bronchoscope Relapse : at least 1 of the initial causative bacterial strains grew at a significant concentration from a second distal sample Multiresistant bacteria : Ticarcillin-resistant P.a., A.b. or S.m., Enterobacteriaceae (ESBL), MRSA Outcome measure Primary outcome : death of any cause, recurrence, antibiotics-fr