抗菌药物应用的原则与策略.pptVIP

* 谢 谢！ * * Bacteria have evolved numerous mechanisms to evade antimicrobial drugs. Chromosomal mutations are an important source of resistance to some antimicrobials. Acquisition of resistance genes or gene clusters, via conjugation, transposition, or transformation, accounts for most antimicrobial resistance among bacterial pathogens. These mechanisms also enhance the possibility of multi-drug resistance. * Once resistant strains of bacteria are present in a population, exposure to antimicrobial drugs favors their survival. Reducing antimicrobial selection pressure is one key to preventing antimicrobial resistance and preserving the utility of available drugs for as long as possible. * Antimicrobial therapy can be life saving and represents one of the greatest medical achievements in the past century. It is essential that efforts to prevent antimicrobial resistance do not compromise the effective treatment of infections in individual patients. For individual patients, appropriate antimicrobial therapy includes choosing the correct antimicrobial drug or combination, proper timing, dosage, and route of administration, and proper treatment duration. * Unfortunately, not all patients receive appropriate antimicrobial treatment. In this prospective study of 2000 patients admitted to an intensive care unit, 655 patients had one or more infections. Treatment of 17.1% of those with community-onset infection was inappropriate; 34.3% of those with hospital-onset infection was inappropriate, and 45.2% of those with a hospital-onset infection complicating a community-onset infection was inappropriate. * This study demonstrates the strong association of inappropriate therapy and mortality. 42% of those who received inappropriate antimicrobial therapy died, compared to 17.7% of those who received appropriate therapy. In other words, the relative risk of mortality among those who received inappropriate therapy was 2.37. The difference in mortality rate was statistically