抗生素概论和合理应用修改.ppt

THANK YOU SUCCESS * * 可编辑 * * 此张主要说明社区获得性呼吸道感染主要疾病组成，最常见且较严重的为CAP与AECOPD。 * * 此张主要强调呼吸道感染的趋势-趋向于多种致病菌的混合感染，故临床需要能全面覆盖呼吸道感染致病菌的抗菌药物。 * 要点： 见幻灯。 * 要点： 见幻灯。 * 要点： 老年CAP的特殊危险因素：吸入因素。在老年CAP的抗生素治疗中，要考虑到吸入因素所致厌氧菌感染的情况。 * * * * * 要点： HAP患者的起病时间与肺炎的病原谱和耐药性有密切关系。 * 要点： 病原学特点：不同国家，不同地区，不同医院HAP病原谱经常存在差异。一般认为：早发性HAP致病菌主要为社区获得性病原体；迟发性HAP的致病菌主要考虑耐药致病菌；大多数HAP，特别是VAP，常由多种致病菌引起；无论早发或迟发性VAP，如合并有危险诱发因素则其病原菌分布应同迟发HAP，同时尚要兼顾军团菌感染。 * * * 头孢克洛、头孢丙烯及头孢曲松对PRSP的耐药率为88.2%,88%和23.5% * * * C. difficile was first described in 1935 by Hall and O’Toole. [Ref. 1 Kelly, p. 375] Although the organism released potent toxins, because it was found in the stool of healthy neonates, it was classified as a commensal and passed into obscurity.[Ref. 1 Kelly, p. 375] Pseudomembranous colitis was first described over a century ago, before the discovery of antibiotics.[Ref. 2: Prendergast, p. 768 Ref. 3: Finney, p53] In the 1960s and 1970s, antibiotic-associated pseudomembranous colitis became a major clinical problem.[Ref. 1 Kelly, p. 376; Ref. 4: Kelly, p. 257; Ref. 5: Settle, p. 1217] Initial outbreaks were traced to the use of clindamycin, cephalosporins, and ampicillin. [Ref. 1 Kelly, p. 376; Ref. 6: deLalla, p. 624; Ref. 7: Privitera, p. 208] Reference Kelly CP and JT LaMont. Annu Rev Med. 1998;49:375-390. 2. Prendergast TM, et al. Surgery. 1994;116:768-775. 3. Finny JMT, et al. Bull Johns Hopkins Hosp. 1893;4:53-55. 4. Kelly CP, et al. N Engl J Med. 1994;330:257-262. 5. Settle CD, et al. Aliment Pharmacol Ther. 1998;12:1217-1233. 6. deLalla F, et al, J Antimicrob Chemother. 1989;23:623-631. 7. Privitera G, et al. Antimicrob Agents Chemother. 1991;35:208-210. * Multidrug-resistant pseudomonal strains are very difficult to treat. Trouillet et al. found that prior use of a fluoroquinolone was an independent risk factor for mortality in VAP, and that prior exposure to fluoroquinolones was significantly associated with resistance to imipenem (p=0.05) and ciprofloxacin (p=0.001). This suggests that