周华其他系统非发酵菌感染概况ppt课件.ppt

不动杆菌UTI 占ICU尿路感染的1.6% 一般为留置管相关UTI 很少引起健康人群社区感染除非有梗阻因素 Clin. Infect. Dis. 41:848–854. CLIN MICROBIOL REV. 2008, 538–582 Transplant Infectious Disease 2011: 13: 638-640 Indian J Med Res 2011: 133:681-684 UTIs中的不动杆菌 印度研究，2007.2-2008.1 32416份尿液标本、6218份细菌性阳性（19.1%） 224株鲍曼不动杆菌群(3.6%)，205例有临床资料 166住院患者，39门诊患者（其中26例行门诊手术，66％）, 导尿管50.3%；尿路梗阻15.1%；尿路肿瘤7.8%;肾脏疾病8.7%；闭合损伤2.9% 无患者死亡 Indian J Med Res 2011: 133:681-684 41.5％MDRAB 22.3%CRAB 14.2%替加耐药 3.5%多粘耐药 3.5%PDRAB Indian J Med Res 2011: 133:681-684 其他感染 心内膜炎 眼内炎 肠炎 妇科炎症 Take home 非发酵菌成为院内感染重要病原菌，包括中枢感染、SSTI、UTI 非发酵菌耐药率高，治疗困难 共同高危因素：手术破坏皮肤粘膜屏障、体内留置管、ICU、抗菌药物使用 去除异物和引流异常重要 距离2012.12.21还有348天！ * Crainotomy 颅骨切开术 External vventricular drain 脑室外引流管插入或置换 ventriculoperitoneal shunt 脑室腹膜分流术 Lumbar drain 腰椎引流术 * 27 patients received iv monotherapy with carbapenems (21 cases), ampicillin/sulbactam (4 cases), ciprofloxacin (1 case) and amikacin (1 case). In 4 cases, a combined parenteral therapy was used with imipenem (three cases) or ceftazidime (one patient) and aminoglycosides.Nineteen patients received a combined iv and intrathecal therapy with colistin (eight cases), iv carbapenems and iv and intrathecal (four cases) or only intrathecal (five cases) aminoglycosides, iv ceftazidime and intrathecal tobramycin (one case) and iv ampicillin/sulbactam and iv and intrathecal amikacin (one case). The mean duration of treatment was 17.4 + 8.3 days (range 3–44). In 36 cases, treatment was associated with the removal of the intraventricular catheter. * 他啶脑脊液峰浓度10mg/L，静脉2g q8h情况下 根据PK/PD模型需要用到12g每天的剂量 * 美罗培南2g剂量使用后脑脊液浓度0.13–1.60 μg/mL 80% probability of achieving 50% and 100% TMIC for MICs of less than or equal to 0.25 μg/mL and 0.125 μg/mL, * 0.65–3.50 μg/mL 90 min after a 1 g sulbactam dose * External ventricular drain EVD On day 53 despite clinical improvement the CSF white cell count rose to 210 · 106/L, so colistin was ceased and the CSF leucocytosis resolved.化学性脑膜炎，2例停脑室内给药、一例减药后缓解。 * Streptococcus agalactiae 无乳链球菌 Listeria monocytog