抗生素英文课件精品PERIOPERATIVEANTIBIOTIC PROPHYLAXISAND SURGICAL SITE .ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * PATHOPHYSIOLOGY Antibiotics cause a reduction in the density of bacteria that normally predominate in the colon. This removes an important protective feature to colonization of the colon by pathogens. C. difficile appears to be well equipped to take advantage of this opportunity. Following increases in their number, the production of exotoxins A and B begins leading to diarrhea, ulceration of the colon, and in some cases death. Toxins produced by C. difficile damage the colonic flora causing accumulation of fibrin, mucin, and dead host cells. Initially this debris forms a pseudomembrane which makes this different from other forms of severe diarrhea. Interestingly, 5-10% of people in the normal population carry C. difficile as a component of their colonic flora. When patients are in a hospital, this increases to around 25% of the population. While C. difficile will die if outside the colon because it is a strict anaerobe and would therefore seem to be a bacteria that would not be transmitted from patient to patient or from healthcare worker to patient, when outside the body it forms a spore which can persist in the environment for many months and survive passage through stomach acid into the colon where the spores germinate in the anaerobic environment of the colon. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * PATHOPHYSIOLOGY of CDAD Three steps necessary for development acquisition of organism (CD) distortion of normal fecal flora (antibiotics) toxin production by CD Risk modified by other “susceptibility” factors (age, surgery, chemotherapy, laxatives, etc.) INCIDENCE Manian FA, et al. Infect Control Hosp Epidemiol. 1995;(2):63-5 CDAD CASES Olson MM., et al.Infect Control Hosp Epidemiol 1994;15:371-381 CDAD AND ANTIBIOTIC USE Clindamycin Restriction Barrier precautions Olson MM., et al.Infect Control Hosp Epi