實證醫學競賽讲解说明.pptVIP

參考資料 參考資料：證據的強度 參考資料：證據等級和臨床建議 Grade of Recommendation Level of Evidence Therapy [A] 1a Systemic review of RCTs 1b Single RCT 1c ‘All-or-none’ [B] 2a Systemic review of cohort studies 2b Cohort study or poor RCT 2c ‘Outcomes’ research 3a Systemic review of case-control studies 3b Case-control study [C] 4 Case series [D] 5 Expert opinion, physiology, bench research 參考資料 * * * * * * * * * * * * * * 新光醫院 EBM 推動小組 實證醫學競賽： CAT 摘要 組別：A 比賽題目 你的PGY course很不幸地從急診展開。今天早上夜班團隊交班說某一床正在等感染科住院的45歲男性病患的血液培養兩套都長GNB，不過還不確定菌種也沒有敏感測試報告。 主治醫師跟家屬解釋，我們目前會使用經驗性抗生素治療（empirical antibiotics），一般來說都會有不錯的療效。這時候家屬說，如果同時使用兩種（有效對抗GNB的）抗生素，會不會對病患更好？ 主治醫師請你查一下目前的evidence，是不是有實證支持同時使用兩種抗生素呢？ 臨床問題 對於血液培養兩套都長GNB的45歲男性病患, 是否可以同時使用兩種抗生素? 問題類型 ■治療 □診斷 □傷害 □預後 搜尋之歷程 請列出你們搜尋的歷程。 文獻研讀：第1篇 題目及出處： β-Lactam and Fluoroquinolone Combination Antibiotic Therapy for Bacteremia Caused by Gram-Negative Bacilli ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Apr. 2009, p.1386–1394 研究設計： Retrospective cohort study level 2b 研究結果分析(要有數據)： 結論: combination therapy with β-lactams and fluoroquinolones was associated with a reduction in 28-day all-cause mortality among less severely ill patients with bacteremia caused by GNB Pitt score single combination 4 8.8% (28 of 319) 4.2% (9 of 214) 4 27.8% (22 of 79) 25.6% (23 of 90) 建議 B NNT 21.7 用combine比較好, score4 文獻研讀：第2篇 題目及出處： 研究設計： 研究結果分析(要有數據)： Level : 2b retrospective cohort study We performed a study with the main goal of determining whether combination antimicrobial therapy directed against Gram-negative bacteria was associated with lower hospital mortality in patients with severe sepsis and septic shock MATERIALS AND METHODS A total of 760 patients were included in the study, 522 (68.7%) received initially appropriate 238 (31.3%) received IIAT The mean age was 59.3 16.3 (range, 18 to 99), Sex: 399 (52.5%) males 361 (47.5%) females. Infection sources community-acquired (n 72, 9.5%), healthcare-associated community-onset (n 269, 35.4%) healthcare-associated hospi