临床抗生素使用.PDF

臨床抗生素使用 2018.03.21 北醫附設醫院感染科莊涵琄 1 Sepsis – in the past 4個有 2個  Vital signs Fever (38.3C) or hypothermia (36) Tachycardia (HR90bpm) Tachypnea (RR 20bpm or pCO2 32 )  Lab: Leukocytosis (WBC 12K/ul) or Leukopenia (WBC 4K/ul) or bandemia 10% 2 Crit Care Med 2003 Vol. 31, No. 4 Sepsis- organ dysfunction (past) 3 Sepsis 2016 criteria 22 =100 4 JAMA 2016; 315(8), p 762- Sepsis - lab ●Leukocytosis (white blood cell [WBC] count 12,000 microL–1) or leukopenia (WBC count 4000 microL–1) ●Normal WBC count with greater than 10 percent immature forms ●Hyperglycemia (plasma glucose 140 mg/dL or 7.7 mmol/L) in the absence of diabetes ●Plasma C-reactive protein more than two standard deviations above the normal value ●Plasma procalcitonin more than two standard deviations above the normal value (not routinely performed in many centers) ●Arterial hypoxemia (arterial oxygen tension [PaO ]/fraction of inspired oxygen [FiO ] 300) 2 2 ●Acute oliguria (urine output 0.5 mL/kg/hour for at least two hours despite adequate fluid resuscitation) ●Creatinine increase 0.5 mg/dL or 44.2 micromol/L ●Coagulation abnormalities (international normalized ratio [INR] 1.5 or activated partial thromboplastin time [aPTT] 60 seconds) ●Thrombocyt