Folie 1课件.ppt

Markus A. Weigand Department of Anesthesiology and Intensive Care Medicine Justus-Liebig-University Gie?en University Hospital Gie?en and Marburg Campus Gie?en * Antibiotic therapy of postoperative sepsis Hit hard and early Preferred antibiotics in severe sepsis Combination therapy Duration of antibiotic therapy Use of antibiotic diversity Conclusion Time is the critical factor ? Rivers et al. 2001 ?Early goal-dircted therapy“ ScVO2≥70% reduces mortality by 15% Kumar et al. 2006 Each hour of delay in antimicrobial administration was associated with a decrease in survival of 5 – 10% 6 h Kumar A et al. ICAAC, 2007: L-477 Critical role of adequate antibiotic therapy Hit hard and early Preferred antibiotics in severe sepsis Combination therapy Duration of antibiotic therapy Use of antibiotic diversity Conclusion Wong PF et al.Cochrane Database Syst Rev 2005Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults No specific recommendations can be made No recent randomized trial for patients with severe sepsis Increasing Resistance for E. Coli G.-T.E.S.T. 1 vs. G.-T.E.S.T. 2; Kresken M et al. Chemother J 2008; 17(5):205-226; Resistant strains (%) Some guidelines recommend a combination therapy in severe sepsisAminoglykosides, Chinolones, Tigecycline Only in patients with risk factors or with proven infections withMDR-bacteria guidelines uniformerly recommend combinations with Vancomycin, Linezolid, Daptomycin or Tigecycline Ceftazidime oder Cefepime + Metronidazole Piperacillin + Beta-Lactamase inhibitor Imipenem, Meropenem or Doripenem Recommended drug groups for empirical antibiotic treatment of severe nosocomial infections Hit hard and early Preferred antibiotics in severe sepsis Combination therapy Duration of antibiotic therapy Use of antibiotic diversity Conclusion Pat. without Shock Pat. with Shock Pseudomonas Bacteraemia There was no difference in 28 day mortality between the combination and monotherapy groups (CI: 0.78-1.42;