课件：耐药背景下的个体化抗菌治疗陈佰义.pptVIP

* The introduction of every new class of antimicrobial agents is followed by emergence of resistance. By 1962, 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. In 1997, 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; the patient was receiving chronic hemodialysis. b内酰胺类抗生素与庆大霉素或氟喹诺酮类抗菌药物体外联合后均略可提高铜绿假单胞菌的敏感率，但庆大霉素的增效作用略强于氟喹诺酮类， VAP－耐药菌感染的危险因素 135 次VAP －ICU 变量 OR P MV7 days 6.0 .009 先期ABs 13.5 .001 广谱ABs 4.1 .025 MV 7 days / prior ABs Trouillet, et al. Am J Respir Crit Care Med. 1998;157:531 No Risk Factors for MDR Pathogens Risk Factors for MDR Enterobacteriaceaea Risk Factors for MDR Pseudomonas Health care contact No Yes! (eg, recent hospital admission, nursing home, dialysis) without invasive procedure Yes, Long hospitalization and/or infection following invasive procedures (5 days) Recent Abx No Yes! (≥14 days in past 90 days) Yes ! (≥14 days in past 90 days) Patient characteristics Young few comorbidities ≥65 yrs comorbidities such as TPN or renal insufficiency co-morbidities such as CF, structural lung disease, advanced AIDS, neutropenia, or other severe immunodeficiency aExcept nonfermenters/non-Pseudomonas species. Adapted from Carmeli Y. Predictive factors for multidrug-resistant organisms. In: Role of Ertapenem in the Era of Antimicrobial Resistance [newsletter]. Available at: www.invanz.co.il/secure/downloads/IVZ_Carmeli_NL_2006_W-226364-NL.pdf. Acce