课件：抗菌药物经验用药的精准化.ppt

Forest plot depicting the risk ratios (RR) of all-cause mortality of patients with infection with high-MIC versus low-MIC Gram-negative isolates. Vertical line, “no-difference” point between the two regimens; squares, risk ratios; diamonds, pooled risk ratios for all studies; horizontal lines, 95% CIs; M-H, Mantel-Haenszel. 一项荟萃分析研究，比较使用碳青霉烯类与其他抗生素治疗产ESBL肠杆菌科细菌菌血症的相关死亡率。 结果显示，与BL/BLIs相比，碳青霉烯类针对性治疗或经验性治疗有降低全因死亡率的趋势（上图为针对性治疗结果）。 研究设计： 研究者在PubMed和Scopus数据库中搜索了相关文献，这些文献均提供了接受碳青霉烯类、β-内酰胺类/β-内酰胺酶抑制剂（BL/BLIs）或非BL/BLIs（主要为头孢菌素类和氟喹诺酮类）期间的死亡率数据，优选单药治疗的研究。研究对象包括了各年龄段的社区和健康护理相关性菌血症患者。对所收集到的数据进行荟萃分析和汇总。旨在比较使用碳青霉烯类与其他抗生素治疗产ESBL肠杆菌科细菌菌血症的相关死亡率。共纳入了21篇文献、1584例患者。大肠埃希菌和肺炎克雷伯菌是最常见的细菌。荟萃分析结果为比较接受碳青霉烯类或其他抗生素针对性和经验性治疗产ESBL肠杆菌科细菌引起的菌血症的全因死亡率。 * * * High-dose and prolonged-infusion carbapenem therapy as part of a combination regimen for CRE with carbapenem MICs ≤4 mg/L Carbapenem-based combinations Plus colistin, tigecycline, or an aminoglycoside Colistin-based combinations Plus a carbapenem, tigecycline, or an aminoglycoside Tigecycline-based combinations Plus gentamicin or colistin Double-carbapenem therapy = “doripenem + ertapenem” Tzouvelekis LS, et al. Clin Microbiol Rev 2012;25:682-707. Outcomes of Infections Caused by KPC-KP According to Treatment Regimen A: 2 active drugs with a carbapenem B: 2 active drugs, not a carbapenem C: Monotherapy with an aminoglycoside D: Monotherapy with a carbapenem E: Monotherapy with tigecycline F: Monotherapy with colistin G: iInappropriate therapy Tzouvelekis LS, et al. Clin Microbiol Rev 2012;25:682-707. 历时4年，5家大型医院661例患者入组 对不同类型CRE感染联合治疗疗效评估 （续） 该文献将碳青霉烯的MIC放宽至8-16 CRE所致不同部位感染的治疗推荐 Open Forum Infect Dis. 2015 Apr; 2(2): ofv050. MIC distributions of 333 CRKP isolates from blood in 2013 in China Zhuo C, et al .CMI 2015, in press High-dose and prolonged-infusion carbapenem therapy as part of a combination regimen for CRE with carbapenem MICs ≤4 mg/L Carbapenem-based combinations Plus colistin, tigecycline, or an aminoglycoside Col