重症肺炎-ppt参考课件.ppt

MDR铜绿假单胞菌感染的高危因素有： 粒细胞缺乏(粒细胞计数<500/mm3) 外科引流及全身营养 住院时间延长(>20天) 插管(包括经鼻胃管、尿路插管、中心静脉插管) 机械通气 既往接受抗菌治疗、化疗和皮质激素治疗 Southeast Asian J Trop Med Public Health.?2011 May;42(3):693-703. Risk?factors?and?clinical?outcomes?of?muLtidrug-resistant?Acinetobacter baumannii bacteremia at a university hospital in Thailand. Anunnatsiri S1,?Tonsawan P. Author information Abstract MuLtidrug-resistant?(MDR) Acinetobacter baumannii has become a major cause of hospital-acquired infection worldwide. There are few papers regarding this particuLar subject. Our aim was to assess the incidence of bacteremia due to MDR Acinetobacter baumannii,?factors?associated with the infection, and?clinical?outcomes. We studied 49 cases of A. baumannii bacteremia in aduLt patients admitted to a university hospital in Northeast Thailand between 2005 and 2007. The incidence of MDR A. baumannii bacteremia was 3.6 episodes per 10,000 hospital admissions. Significantly independent?factors?associated with MDR A. baumannii bacteremia were previous: 1) ICU admission [odds ratio (OR) 10.01; 95% confidence interval (CI) 1.39-72.20]; 2) use of beta-lactam/beta-lactamase inhibitor antibiotics (OR 8.06; 95%CI 1.39-46.64); and 3) use of a carbapenem antibiotics (OR 11.40; 95%CI 1.44-89.98). The overall mortality rate was significantly higher in the MDR group than in the susceptible group (91.7% vs 48%, respectively) (p=0.001). The significantly independent?factors?related to mortality were: 1) APACHE II score (OR 1.25; 95%CI 1.03-1.52) and 2) secondary bacteremia (OR 14.86; 95%CI 1.37-161.90). This study revealed the significantly independent?factors?associated with MDR A. baumannii bacteremia were prior ICU admission and prior use of broad spectrum antibiotics. This infection has a high mortality rate. Emphasis needs to be on prevention, strict application of infection control and appropriate use of antibiotics. * MDR G-菌感染高危因素汇总见上。 * * * * 美罗培南治疗产ESBL重症感染的首选 国外文献也指出了碳青霉烯治疗产ESBL重症感染的首选的三大理由：碳青霉烯不被ESBL水解 最小的接种效应 碳青霉烯治