抗生素英文课件精品Appropriate Antibiotics use in CAP and HCAP at Sisters Hospital in .pptVIP

Appropriate Antibiotics use in CAP and HCAP at Sisters Hospital in 2008. Syed Faraz Masood, MBBS Nashat H. Rabadi, MD, FCCP Community Acquired Pneumonia Common : 5 to 6 million cases/year 20% are hospitalized ( 10% in ICU) No. 1 cause of death from infectious disease No. 6 cause of death in adults Mortality rates : Outpatients = 1-5% Inpatients = 12% ( higher in ICU- 50%) Costs : 9.7 billion : inpatient – $7,517 vs. outpatient - $264 CAPDefinition CXR – infiltrate Auscultatory findings Signs of RTI Cough +/- sputum Fever or hypothermia WBC CAP - Pathogenesis Aspiration Inhalation Hematogenous Direct extension Reactivation Risk Factors. Age. Smoking. Co-morbid Conditions. Poor Prognosis. Pleural Effusion. Bacteremia. Cultures. Sputum Cx Not needed as outpatient. May or may not be needed inpatient. Blood Cx Urinary Antigens. CURB - 65 Management. Site of Care: Inpatient vs. outpatient. Floor vs. ICU. PSI CURB 65 Empirical Treatment Hospitalized Patients: 2nd or 3rd generation Cephalosporins plus a Macrolide. Floroquinolones. For all critically ill patients, 2nd or 3rd generation Cephalosporin + Macrolide or Floroquinolones – necessary to provide coverage for Legionella Pneumophilia. Change antibiotics – based on culture and sensitivity. Nosocomial Pneumonia Hospital Acquired Pneumonia: 48 hours of admission to hospital. Ventilator associated Pneumonia. 48 hours of intubation. Health-care Associated Pneumonia. Antimicrobial therapy in preceding 90 days. Hospitalization for 2 or more days in the preceding 90 days. Residence in a NH or an extended care facility. Home infusion therapy. Chronic Dialysis within 30 days. Immunosuppressive state and/or therapy. Health-care Associated Pneumonia. Epidemiology extrapolated from HAP/VAP Second most common Nosocomial Infection. High morbidity / mortality. Increase hospital stay by 7-9 days. Excess cost of $ 40,000 per patient. Early VAP/HAP (5 days) Simi