课件：恶性血液病粒缺期感染的防治.ppt

* These data show the susceptibility of some common nosocomial pneumonia pathogens to various antimicrobials that may be used in the ICU. Most of the agents show good activity against K. pneumoniae and S. marcescens, though levofloxacin shows the highest activity against E. cloacae and S. maltophilia. Imipenem and piperacillin/tazobactam are most effective against P. aeruginosa, though combination therapy is usually recommended for patients suspected of this kind of infection. * A clinician should view antibiotics in terms of their inherent anti-pseudomonal activity along with their resistance potential. A high degree of anti-P. aeruginosa activity should not be the determining factor for an antibiotic if the agent has a high resistance potential, which will likely render it ineffective and potentially spread resistance to other anti-pseudomonal agents. Agents with a high resistance potential include ceftazidime, imipenem, gentamicin, and ciprofloxacin. Agents with a low-resistance potential have been used in high volume over long periods of time and maintain their effectiveness. These agents include cefepime, meropenem, pip-tazo, and amikacin. Levofloxacin shows good activity against P. aeruginosa and a low resistance potential, thus making it a possible effective agent in the long-term use against this difficult pathogen. Levofloxacin is currently recommended to be used in combination with an anti-pseudomonal beta-lactam for P. aeruginosa infections. * Comparison of new agents: Impressive profile of in vitro activity against a range of yeasts, filamentous fungi, and dimorphic pathogens Amphotericin B still has the broadest spectrum Clinical outcome depends on other factors besides in vitro activity AMB = amphotericin B, FCZ = fluconazole, ITZ = itraconazole, VZ = voriconazole, PCZ = posaconazole, RCZ = ravuconazole, CF = caspofungin, MF = micafungin, AF = anidulafungin * * * 恶性血液病患者粒缺期感染的经验性治疗 IDSA-美国感染性疾病协会主张糖肽类抗生素仅在高度怀疑革兰氏阳性球菌感染患者中有针对性、有限制的使用， 包括： 一些皮肤、导管源感染