厄他培南对控制院耐药环境的价值.pptVIP

* * * * * * * * * * * * * IVZ 2008-W-1259216-SS MS* In the current era of multidrug resistance, antibiotic stewardship—adequate and responsible antibiotic use—is essential. Specifically, clinicians must attempt to choose antimicrobial agents that are effective against target organisms yet have a low propensity for resistance.1 There are several challenges to antibiotic stewardship in this era of highly prevalent multidrug-resistant gram-negative organisms. Extended-spectrum β-lactamases (ESBLs), which are resistant to cephalosporins, fluoroquinolones, trimethoprim, and aminoglycosides, are now susceptible only to carbapenems because of their unique chemical structure and properties.2,3 While attempting to optimize outcomes for individual patients, however, clinicians must consider the widespread consequences of carbapenem overuse, including increased multidrug resistance among gram-negative pathogens, including Pseudomonas aeruginosa and Acinetobacter spp.4,5 NEW References Weber DJ. Collateral damage and what the future might hold. The need to balance prudent antibiotic utilization and stewardship with effective patient management. Int J Infect Dis. 2006;10(S2):S17–S24. Livermore DM. Minimising antibiotic resistance. Lancet Infect Dis. 2005;5:450–459. Hammond ML. Ertapenem: a group 1 carbapenem with distinct antibacterial and pharmacological properties. J Antimicrob Chemother. 2004;53(suppl S2):ii7–ii9. Jacoby GA, Munoz-Price LS. Mechanisms of disease: the new β-lactamases. N Engl J Med. 2005;352(4):380–391. Livermore DM. The need for new antibiotics. Clin Microbiol Infect. 2004;10(suppl 4):1–9. 1/Weber, p S21, C1, ?1, L1-4; p S22, C1, ?2, L11-17, C2, L1-3 2/Livermore LID 2005, p 453, C2, Panel 1, Title, ?3, L4-6 3/Hammond, p ii8, C1, L17-24 4/Jacoby, p 387, C1, ?2, L1-5; p 388, C1, L1-6 5/Livermore 2004, p 3, C1, ?1, L1-7; p 7, C2, ?1, L4-6, 9-12 Bullet 1: 1/Weber, p S21, C1, ?1, L1-4; p S22, C1, ?2, L11-17, C2, L1-3 Bullet 2: 2/Livermore LID 20