头孢菌素对β-内酰胺酶的稳定性.PPT

* 住院部分来看，各个协会的意见基本一致。 普通病房： b-内酰胺类＋ 大环类、氟喹诺酮类 ICU： b-内酰胺类＋ 大环类/氟喹诺酮类，或氟喹诺酮类单用，其中ATS更细致地划分有/无绿脓感染，但治疗方案还是与其他协会基本相似。 * Slide * Based on the national guidelines for initial empiric treatment of patients with hospital-acquired pneumonia (HAP), proposed by the American Thoracic Society (ATS), HAP is defined as pneumonia occurring >48 hours after admission and excluding any infection that is incubating at the time of admission. HAP is a major cause of morbidity and mortality, especially in the complex environment of the intensive care unit (ICU), and is the second most common nosocomial infection in the United States. The lack of sensitive diagnostic methods and the increasing prevalence of nosocomial pathogens with multiple antibiotic resistance complicate patient management. HAP patient deaths directly attributable to infection have been estimated to be as high as 50%, with even higher mortality rates if bacteremia or certain pathogens are involved1 * * All these studies show that modifying an initial inadequate therapy (including no initial antibiotic therapy), according to microbiological results, in severely ill patients with VAP does not translate into a better outcome. This is probably because the time window is too short to change an inappropriate antibiotic therapy regimen soon enough to reduce mortality in patients with VAP. This relates to the controversies in diagnosing VAP, since invasive diagnostic methods are unlikely to impact mortality in VAP patients unless they increase the likelihood of adequate initial therapy, and no study has claimed that these methods are capable of creating such a result. (Gert H?ffken, et. al. Nosocomial Pneumonia* The Importance of a De-escalating Strategy for Antibiotic Treatment of Pneumonia in the ICU. CHEST 2002; 122:2183–2196) 医生必须确保抗生素给药满足合理用药的最低要求，例如适当剂量、给药间隔监测药物水平，避免有害的药物相互作用，不满足这些底线，会导致患者获得不理想的抗生素浓度，这会增加治疗失败的几率、抗生素耐药和对患者产生毒性[15,16]. * * Slide * The core organisms for group 1 include S. pneumoniae, methicillin-sens