抗生素PPT课件（英文精品）Multidrug resistant pathogens（67p）.pptVIP

Empiric Therapy Empiric therapy is not an educated guess but a sophisticated decision based on intimate knowledge of The bug The host The local environment All available options ? Antimicrobials ? Principles of antimicrobial therapy ? Supportive and critical care Take home Empiric therapy is overrated Diagnostic effort is underrated Consider going narrow (may be diagnostic) Your empiric therapy will save some, not save some (if you do not get it right), or in some cases kill someone * Mixed; 29 reported Yes, they conducted some surveillance activity for MRSA; 23 had MRSA reportable in some form and all or selected area. * South West Pacific * * 25% of E. coli ESBL (3% Europe, 79 % India, 50% Egypt, 22% Thailand) Antibiotic use not predictive except for ciprofloxacin 5/21 persistently colonized 156 pts affected 35% of kitchen surfaces colonized 6 of 44 (14%) of food workers fecal carriers 2 y.o. from China Adopted Secondary transmission in family Modified Hodge Test Lawn of E. coli ATCC 25922 1:10 dilution of a 0.5 McFarland suspension Imipenem disk Test isolates Described by Lee et al. CMI, 7, 88-102. 2001. Which is more dangerous? Resistance in gram-positive organisms 1990 1997 2000 PRSP 4% 30-50% 48% VTSP 0.2% 3.6-5.1% MRSA 20-25% 25-50% GISA 0 0.1 0.1 VRE 0.1 15 21 Evolution of E. faecium resistance MIC90 of E. faecium 1968 1969-88 1989-90 Penicillin 8 64 512 Ampicillin 2 32 128 % VRE 0 0 61% Grayson et al, AAC Community acquired (ca-) MRSA strains generally CANNOT be distinguished from hospital acquired strains by the presence of: MEC-A gene SCC pattern Panton-Valentine leukocidin Why is this different? Outbreaks in new populations Different disease spectrum (boils, CAP) Spider bite history Specific clones SCCmec type IV Panton-Valentine Leukocidin (PVL) Susceptible to many antib