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脓毒血症的抗生素治疗（英文PPT）Antibiotics for Severe Sepsis and Septic Shock课件
The Data seems pretty clear, so why is there so much controversy surrounding Rivers’ original study? How Do We Do It? Recognize early - 2 SIRS criteria + suspected infxn and lactate 4 But Don’t Forget ! How Do We Do It? Board to ICU immediately Obtain Blood Cultures (1C) and culture indwelling catheters (48 hrs) Antibiotics within the 1st hour for severe sepsis (1D) and septic shock (1B) Surviving Sepsis Campaign Funding from Eli Lilly ? – Yes; Won’t discuss APC Guidelines accepted by ACEP and SCCM Antibiotics for Sepsis Avoiding Pitfalls West Side at Montefiore… Lactate = 6 Chemistry still pending CXR Pending Foley placed – minimal urine Pitfall No. 1 “I SHOULD WAIT FOR A SOURCE BEFORE STARTING ANTIBIOTICS” Pitfall No. 2 “I MUST KNOW THE CREATININE BEFORE GIVING THE FIRST DOSE OF ABX” Kidney Function Pea, et al – Retrospective Study in which therapeutic drug monitoring (TDM) results were analyzed in critically ill patients over a 7-year period “the percentage of patients receiving appropriate loading was inversely correlated with their degree of renal function, decreasing from 60.4% in the case of normal renal function to 26.8% and 5.5%, respectively, in cases of moderately or totally impaired renal function.” According to Pea, et al “the need for appropriate loading at the commencement of therapy is independent of the patient’s renal function” and that “in the absence of loading, several days may be required to achieve therapeutically effective concentrations” These patients had suboptimal concentrations persisting at Day 4 of treatment Kidney Function Zimmerman, et al – Retrospective review of kidney function and Vanc levels - No statistically significant correlation between nephrotoxicity and initial serum creatinine, days of hospital stay, or days of vancomycin therapy. Pitfall No. 3… UNDERESTIMATING THE IMPORTANCE OF THE LOADING DOSE Hydrophilic vs Lipophilic Hydrophilic Abx =PCNs, Aminoglycosides, Cephalosporins Diffuse more slowly into deep-seated sites o
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