解析重症感染的抗感染治疗策略.PPTVIP

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), antipseudomonal cephalosporin, aztreonam, or carbapenem. Vancomycin is recommended for patients at risk of S. aureus infection until MRSA is excluded (in groups 2 and 3). The Centers for Disease Control and Prevention (CDC), the NationalInstitutes of Health (NIH), and the Food and Drug Administration (FDA) led a task force of 10 agencies to develop a comprehensive plan to address the emerging threat of antimicrobial resistance One of the top priority items in the plan is “In collaboration with many partners, develop and facilitate the implementation of educational and behavioral interventions that will assist clinicians in appropriate antimicrobial prescribing” In conjunction with the CDC Foundation, corporate partners, professional societies, healthcare organizations, public health agencies, and expert consultants, the CDC’s Campaign to Prevent Antimicrobial Resistance is a nationwide effort to address this priority De-Escalation to Monotherapy in HAP 对于非铜绿假单孢菌感染,单药治疗恰当 －包括： －环丙沙星,伊米配能－MP, et al. AAC 1994;38:547-557 － 美罗培南,头孢吡肟, pip/tazo，可能包括大剂量左氧氟沙星 － Clin Ther 2003; 25: 485 对于严重VAP只用单药治疗进行降阶梯策略 对于假单孢菌感染,联合氨基糖苷类药物不比 单药治疗好 其它联合(如?－内酰胺类/喹诺酮类)不清 是氨基糖苷类的问题吗？ 肺脏穿透性差酸性 pH低时活性不佳 肾脏毒性限制其应用 De-Escalation to Monotherapy in HAP VAP的短疗程治疗 前瞻性,多中心、随机研究：初始恰当治疗 前提下，比较8天 (n=197) vs 15天(n=204)治疗的临床效果 28天病死率、复发率相似 短程治疗组： 不用抗菌药物时间长(p0.001)； 再感染者MDR病原体少； (42.1% vs. 62%, p=0.04) 非发酵菌感染的细菌学失败率高 (40.6% vs. 25.4%, p=0.06)