课件：细菌耐药监测的方法和意义.pptVIP

合理用药之我见（三） 制订如何使用和不使用抗生素的指南 检查和督促指南的实施 抗生素交替使用（降低选择压力） Guideline on antibiotic usage When to use antibiotics not Do not use… Do not use antibiotics for the common cold Do not use antibiotics for uncomplicated acute bronchitis Do not use antibiotics for non-GABHS acute pharyngitis Do not use antibiotics for acute viral rhinosinusitis Do not use antibiotics for initial treatment of OME 小结 临床分离细菌对常用抗生素的耐药问题已相当严重。为控制细菌耐药性的进一步发展，必须做好以下工作： 1. 临床微生物科必须及时、准确地做好病原菌的分离、培养和药敏试验，要具备检测特殊细菌耐药机制的能力，并对结果予以解释。以帮助临床正确选择抗生素，合理用药以避开细菌的耐药机制。 2. 临床微生物科和医院感染控制部门要做好细菌耐药监测工作，要将监测和分析的结果及时公布，并反馈至有关领导和药事委员会，以制订合理应用抗生素的政策，采取干预措施，从总体上控制和限制抗生素的用量，避免因某些抗生素使用过多而造成选择性压力。 3. 医院感染控制部门要做好消毒隔离等各项感染控制措施，避免因交叉污染而造成耐药菌株的传播。 后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 主要经营：课件设计，文档制作，网络软件设计、图文设计制作、发布广告等 秉着以优质的服务对待每一位客户，做到让客户满意！ 致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求 * Frank Cockerill at Mayo Clinics said delay of 3 days is too long for effective infection control. Plasmid-mediated AmpC ?-lactamases may be worse than ESBLs – reported in this country 1989 – 15 yrs ago. Probably time to try to stop them spreading. * It’s possible – J. Black * Elevated imipenem MIC – use Etest – activity restored by EDTA – simple test Medium critical – read paper JCM 2002 40: 2755-2759 Mueller-Hinton agar (97% sensitivity) better than Iso-Sensitest (93% sensitivity) or Nutrient agar. Difco Mueller-Hinton agar yielded false positive results. BD, Oxoid and Remel were better. * * Must avoid giving bacteria the opportunity to cause outbreaks of resistance Explain critical mass issues Must know prevalent resistance mechanisms to make decisions – can then predict if heading for resistance problems = why some antibiotics have lower critical masses than others. If the resistance genes are already present, you are going to run into problems relatively quickly if you use an antibiotic a lot. This specific information lets you know which drugs are causing pro