抗生素的合理使用讲义.pptVIP

* 住院部分来看，各个协会的意见基本一致。 普通病房： b-内酰胺类＋ 大环类、氟喹诺酮类 ICU： b-内酰胺类＋ 大环类/氟喹诺酮类，或氟喹诺酮类单用，其中ATS更细致地划分有/无绿脓感染，但治疗方案还是与其他协会基本相似。 * Slide * Based on the national guidelines for initial empiric treatment of patients with hospital-acquired pneumonia (HAP), proposed by the American Thoracic Society (ATS), HAP is defined as pneumonia occurring 48 hours after admission and excluding any infection that is incubating at the time of admission. HAP is a major cause of morbidity and mortality, especially in the complex environment of the intensive care unit (ICU), and is the second most common nosocomial infection in the United States. The lack of sensitive diagnostic methods and the increasing prevalence of nosocomial pathogens with multiple antibiotic resistance complicate patient management. HAP patient deaths directly attributable to infection have been estimated to be as high as 50%, with even higher mortality rates if bacteremia or certain pathogens are involved1 * * Slide * The core organisms for group 1 include S. pneumoniae, methicillin-sensitive S. aureus (MSSA), H. influenzae, and enteric gram-negative bacilli. The ATS recommends monotherapy for HAP patients in this group, including second-generation cephalosporins, a ?-lactam/?-lactamase inhibitor combination (piperacillin/tazobactam, ticarcillin/clavulanate), or a non-pseudomonal third-generation cephalosporin (cefotaxime or ceftriaxone). A fluoroquinolone, or clindamycin plus aztreonam, may be considered for penicillin-allergic patients, provided that S. pneumoniae is ruled out. * Slide * The most challenging issue in treating HAP is selecting appropriate empiric antibiotics for patients in group 3. ATS recommends the addition of antimicrobial agents effective against P. aeruginosa and Acinetobacter species to the group 1 antibiotics; this includes an aminoglycoside or fluoroquinolone in combination with an antipseudomonal b-lactam, with or without a b-lactamase inhibitor (e.g., piperacillin/tazobactam), antipseudomona