早发HAP原则-林i其昌推荐.pptVIP

* 要点： 尽量选择耐药MSW窄的抗菌药物：莫西沙星对细菌耐药选择显著低于环丙沙星、氧氟沙星、左氧氟沙星等，对于呼吸道感染应优先选择这些药物。 * 要点： 加拿大连续近20年肺炎链球菌耐喹诺酮类监测证明，长期应用左旋氧氟沙星，是细菌对喹诺酮类耐药原因。 * 要点：加拿大细菌耐药监测数据显示肺炎链球菌对氟喹诺酮类的耐药率在下降 加拿大细菌耐药监测网1988-2004年的数据显示：来自老年患者呼吸道的肺炎链球菌菌株对氟喹诺酮类的 耐药率在2002年达到最高点后，近两年出现了下降，这是什么原因呢？ * 原因： 1 只是耐药率在正常范围内的变异？ 2 样本错误？ 3 耐药克隆株的消失？ 4 氟喹诺酮用量的减少？ 5 使用氟喹诺酮药物种类变化？ * 要点：加拿大用于呼吸道感染的氟喹诺酮类药物处方量的增长主要来自于莫西沙星等新喹诺酮 加拿大1988-2004年的数据显示：该国用于呼吸道感染的“呼吸氟喹诺酮”处方量逐年增加，在2001年前主要是使用左氧氟沙星，其在2001年达到最高点后即稳定在300000左右的水平，其后的增长主要来自于莫西沙星和加替沙星，尤其是莫西沙星，其处方量在2004年已经超过了左氧氟沙星。 * 要点： 见幻灯。 * 要点： 见幻灯。 * * Slide * A presumptive clinical diagnosis of pneumonia is often made when patients develop a new radiological infiltrate associated with fever, leukocytosis, and purulent tracheal secretion, and when microorganisms are isolated by nonquantitative analysis of endotracheal aspirates.1 This clinical approach may lead to an overestimation of the incidence of HAP because cases of tracheobronchial colonization and non-infectious etiologies mimicking HAP may be included in the diagnosis. Therefore, patients may be exposed to antibiotics unnecessarily, potentially leading to the emergence of resistant pathogens and drug-related toxicity. Furthermore, this approach may delay the diagnosis of the true cause of fever and pulmonary infiltrate.1 * Slide * In contrast to clinical diagnosis, invasive diagnostic methods, including quantitative cultures of specimens obtained by a bronchoscopic protected specimen brush or bronchoalveolar lavage, have also been evaluated. A recent randomized study of invasive and non-invasive (clinical) strategies for diagnosing HAP demonstrated that quantitative bronchoscopic specimen cultures (invasive) lead to more appropriate use of antibiotics (i.e., fewer inappropriate treatments and shorter treatment courses), which is followed by improved survival. However, it is important to note that these invasive bronchoscopic procedures are also technically challenging and not universally available