危重病人优化抗感染治疗策略ppt课件.ppt

The prevalence of ESBL production by K pneumoniae approaches 50% in some countries, with particularly high rates in Eastern Europe and Latin America. Paterson and colleagues launched a prospective study of 455 consecutive episodes of K pneumoniae bacteremia in 12 hospitals in 7 countries and found that 85 episodes were due to ESBL-producing organisms. The study looked at antibiotic choices and their effect on mortality. 今、模式図を用い緑膿菌のカルバペネム系抗生物質に対する ４つの耐性機構として OprDの欠損による外膜透過性の低下、 メタロβ－ラクタマーゼ、つまり不活化酵素の産生 ＯｐｒＭの亢進による排出系ポンプの亢進 ＰＢＰの変異 についてお話させていただきましたが、 先ず、OprDの欠損による外膜透過性の低下が、各カルバペネム系抗生物質の抗菌活性に どのような影響を与えるか、についてお話させて頂きます。 OprD的缺失引起外膜通透性的下降，下面谈一下OprD缺失对各类碳青霉稀类抗生素的影响。 In a univariate analysis of a comparison of the mean values of the group with a PRPA VAP and the group with a PSPA VAP: Prior antimicrobial therapy with imipenem (P=.04) or a fluoroquinolone (P=.007) was associated with piperacillin-resistant P aeruginosa ventilator-associated pneumonia. This was in addition to more different classes of antibiotics administered before VAP (P=.01 [Data not shown]). A third-generation cephalosporin had been prescribed more frequently to the PRPA group, but the difference between the 2 groups did not reach statistical significance. The analysis was conducted, and this chart was organized according to the antibiotic class of antimicrobial therapy that had been prescribed during the 15 days preceding the diagnosis of VAP using fiberoptic bronchoscopy. Possible causes for lack of clinical response to initial antibiotic therapy include the wrong organism, the wrong diagnosis, or other complications. ATS/IDSA Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416. At present, a short-term antimicrobial treatment regimen is rarely prescribed, despite the potential major advantages it could have in terms of bacterial ecology and prevention of the emergenc