脓毒血症的抗生素治疗（英文PPT）Antibiotics for Severe Sepsis and Septic Shockppt课件.pptVIP

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脓毒血症的抗生素治疗（英文PPT）Antibiotics for Severe Sepsis and Septic Shockppt课件.ppt

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脓毒血症的抗生素治疗（英文PPT）Antibiotics for Severe Sepsis and Septic Shockppt课件

* * * * Abx Dosing *Taken from 2005 IDSA/ATS Guidelines Double Gram Negative Coverage? Safdar, et al – Meta-analysis of 3077 pts across 17 studies – 2 out 17 studies found benefit, 1 found increased mortality, 14 showed no benefit* Prospective Studies were separated out and still no benefit Cochrane Review of 7586 pts comparing PCN + AG to PCN alone for Gram neg sepsis – No mortality benefit** *Safdar, et al. Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. Lancet Infect Dis. 2004 Aug;4(8):519-27. **Paul M, et al. Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD003344. Why No Benefit? Likely due to increased potency of newer antibiotics Studies that showed benefit were older studies comparing older drugs Surviving Sepsis Guidelines – No evidence for double coverage but… What about Pseudomonas? Recently hospitalized patients NH patients Vent dependent patients Indwelling tubes/lines Double Pseudomonas Coverage? Safdar, et al – Same study in 3077 pts – found benefit to double coverage when Pseudomonas was isolated Surviving Sepsis Guidelines – double cover if suspecting Pseudomonas (2D) Neutropenic Patients IDSA – double gram neg coverage is recommended* Surviving Sepsis Guidelines – double gram neg coverage is recommended (2D) * Hughes WT, Armstrong D, Bodey GP, et al: 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. . Accessed July 10, 2007 Klastersky J: Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis 2004;39(Suppl 1):S32–S37 In Summary…The Evidence Says Recognize Severe Sepsis and Septic Shock Get Appropriate Antibiotics on board early Broad coverage recommended Full LD regardless of kidney function Double coverage if suspected pseudomonas or neutropenic pts In Summary…The Evidence Says Place the Central Lin