-01-16-细菌耐药的临床对策-tzc-final.pptVIP

* 卓越的抗厌氧菌活性是特治星抗菌活性钟的又一大特色。 由于头孢派酮，头孢他啶和头孢吡肟对厌氧菌中的主要组成部分– 脆弱拟杆天然耐药，使得特治星比上述头孢菌素有着更大的优越性。 因为他坐吧坦可以有效抑制厌氧细菌产生的多种酶，所以特治星对厌氧细菌有极高的抗菌活性。在2001年AAC杂志（国际权威杂志）的报道中，特治星队556株厌氧细菌的敏感率为100%，高于临床上常用于治疗厌氧菌感染的抗生素甲硝唑（99%）和克林霉素（77%）。 经验使用特治星治疗中重度感染，可以有效的覆盖厌氧细菌，从而使医生不必担心是否存在厌氧菌混合感染。 哌拉西林和他唑巴坦的组织分布极为广泛，由于二者平行的药代动力学特征，二种药物可以以相同的速度分布到各个组织当中去，同时药物浓度均可以达到远远大于常见细菌的MIC值，而且体内药物比例最大程度的近似体外。 Slide * The most challenging issue in treating HAP is selecting appropriate empiric antibiotics for patients in group 3. ATS recommends the addition of antimicrobial agents effective against P. aeruginosa and Acinetobacter species to the group 1 antibiotics; this includes an aminoglycoside or fluoroquinolone in combination with an antipseudomonal b-lactam, with or without a b-lactamase inhibitor (e.g., piperacillin/tazobactam), antipseudomonal cephalosporin, aztreonam, or carbapenem. Vancomycin is recommended for patients at risk of S. aureus infection until MRSA is excluded (in groups 2 and 3). 目前的治疗选择包括单药治疗(头孢他啶、头孢吡肟、亚胺培南、美罗培南、或哌拉西林/他唑巴坦)。两种药物联合治疗 (氨基糖苷类+一种广谱?-内酰胺类，两种?-内酰胺类联合，或者一种?-内酰胺类+一种氟喹诺酮类)。最后，还可以选择在单药治疗或两种药物治疗的基础上，加用万古霉素。如果有粘膜炎或静脉穿刺部位感染的证据，或者患者以前有携带甲氧西林耐药金葡菌（MRSA）的病史，或者曾经用氟喹诺酮类预防感染，这些情况下经验治疗方案中可以包含万古霉素。 Implementation of several measures need to be applied to control antibiotic resistance. Recommendations include: surveillance, ID consultation, infection control, molecular identification of resistance mechanisms, antibiotic control, and education programs. IDSA and the Society for Healthcare Epidemiology of America (SHEA) have issued guidelines for developing institutional programs to enhance antimicrobial stewardship, including appropriate selection, dosing, route, and duration of antimicrobial therapy. As with any antimicrobial stewardship program, the primary goal is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic organisms, and the emergence of resistance.1 The guidelines note tha