课件：OC与新医改韦志福20110810南宁市.ppt

* * * * * * * * * * In 21st century – articles on resistance, superbugs, and the prospects of a post-antibiotic era. Situation due to earlier Complacency about importance of bacterial infections Belief that development of antibiotics had controlled infectious diseases * Once a pathogen produces infection, antimicrobial treatment may be essential. However, antimicrobial use promotes selection of antimicrobial-resistant strains of pathogens. As the prevalence of resistant strains increases in a population, subsequent infections are increasingly likely to be caused by these resistant strains. Fortunately, this cycle of emerging antimicrobial resistance / multi-drug resistance can be interrupted. Preventing infections in the first place will certainly reduce the need for antimicrobial exposure and the emergence and selection of resistant strains. Effective diagnosis and treatment will benefit the patient and decrease the opportunity for development and selection of resistant microbes; this requires rapid accurate diagnosis, identification of the causative pathogen, and determination of its antimicrobial susceptibility. Optimizing antimicrobial use is another key strategy; optimal use will ensure proper patient care and at the same time avoid overuse of broad-spectrum antimicrobials and unnecessary treatment. Finally, preventing transmission of resistant organisms from one person to another is critical to successful prevention efforts. * * * * 关于各种感染相关检测项目分析 新生儿细菌感染缺乏特异性临床表现，虽然血培养阳性仍是诊断新生儿败血症的金标准，但其阳性率较低，且耗时较长，难以作为应用抗生素的早期指标。 细菌感染的间接实验室指标如WBC、中性粒细胞碱性磷酸酶积分(NAP)和内毒素检查，目前普遍应用于临床实践，但还不能满足抗感染治疗的实际需要。 在临床实际工作中，开展POCT CRP对于确定感染病原体的大类，提前采取合理有效的措施控制感染性疾病，合理使用抗生素已得到专家学者和不少医务人员的认同。 CRP检测可降低医疗成本，减轻患者经济负担 医生不能及时对病原微生物做出明确诊断时，常根据经验治疗方式选用抗生素进行治疗，从而导致临床滥用抗生素的现象极为普遍。 POCT CRP检测的普及和应用，在很大程度上使临床医生对急性呼吸道、泌尿道和肠道感染病原体的诊断上，可以做到快速、准确。 目前随着诊断技术的发展，CRP其POCT方式的检测下限可以达到0.5mg/L，检测上限可以达到200mg/L（称为：超敏CRP或全程CRP），该种检测方法将可以满足新生儿、儿童及成人的诊断需求。 适合使用于门诊、病房和家庭的快速检测、甄别病原微生物的大类，是鉴别细菌或病毒感染的一个首选指标。 CRP浓度的解释