课件：ICU多重耐药菌流行现状与控制方法.pptVIP

* Introduction of every new class of antimicrobial drug is followed by emergence of resistance. By the 1950s, penicillin-resistant S. aureus were a major threat in hospitals and nurseries. By the 1970s, methicillin-resistant S. aureus had emerged and spread, a phenomenon that encouraged widespread use of vancomycin. In the 1990s, vancomycin-resistant enterococci emerged and rapidly spread; most of these organisms are resistant to other traditional first-line antimicrobial drugs. At the end of the century, the first S. aureus strains with reduced susceptibility to vancomycin were documented, prompting concerns that S. aureus fully resistant to vancomycin may be on the horizon. In June 2002 the first case of vancomycin-resistant S. aureus was detected. * Once antimicrobial therapy is started, it is often difficult to stop, even when there is no indication for ongoing treatment. However, in some cases, unnecessary antimicrobial treatment may actually harm patients and add to treatment costs. * This randomized unblinded clinical trial of patients in a Veteran’s Administration Medical Center was designed to assess a pragmatic approach to use of antimicrobials in the ICU. Eligible patients had new-onset pulmonary infiltrate and a low clinical pulmonary infection score (CPIS = 6), indicating that pneumonia was unlikely Clinicians selected treatment for those in the standard group; 18 different antimicrobials were prescribed alone or in combination to those in this group. Patients in the experimental group were treated with ciprofloxacin monotherapy for 3 days; after 3 days, treatment was stopped unless the CPIS 6 or infection at another site was documented. Patients in the experimental group had less antimicrobial exposure and less emergence of antimicrobial resistance / superinfection. Their length of stay was shorter and their antimicrobial treatment cost was lower. The difference in 30-day mortality rates for the 2 groups was not statistically significant. Over ti