感染病患者多重耐药菌感染风险诊断演示文稿.pptxVIP

感染病患者多重耐药菌感染风险诊断演示文稿当前第页\共有49页\编于星期五\9点（优选）感染病患者多重耐药菌感染风险诊断当前第页\共有49页\编于星期五\9点Discovery of Antibacterial AgentsEmpiric screeningSynthetic approachesCycloserine Erythromycin EthionamideIsoniazidMetronidazolePyrazinamideRifamycinTrimethoprim Vancomycin VirginiamycinNewer macrolides ketolidesRifampicinRifapentineSemi-synthetic glycopeptidesSemi-synthetic streptograminsChlortetracyclineMinocyclineGlycylcyclinesNewer carbapenemsImipenemCephalosporin CTrinemsSemi-synthetic penicillins cephalosporinsPenicillinProntosilChloramphenicol Neomycin Polymixin Streptomycin ThiacetazoneOxazolidinonesCecropinEthambutolFusidic acidNewer aminoglycosidesMupirocinNalidixic acidFluoroquinolones19301940195019601970198019902000当前第页\共有49页\编于星期五\9点临床关注的耐药问题Resistances of Clinical Concerns? 革兰阳性细菌金匍菌– MRSA, VISA, VRSAVRE (地理上差别)肺炎链球菌 –青霉素和大环内酯耐药? 革兰阴性细菌肠杆菌科◆ESBLs-喹诺酮,头孢菌素,青霉素类,氨基糖苷类碳青霉烯酶（KPC, NDM-1?）-碳青酶烯耐药在中国出现和蔓延非发酵菌(假单孢菌/不动杆菌)喹诺酮, 头孢菌素,青霉素类,氨基糖苷,碳青霉烯类当前第页\共有49页\编于星期五\9点Control of Antibiotic ResistanceAntibiotic Control and Infection Control:The Two Sides of the Resistance “Coin”ESBLK. pneumoniaeMRSA ABVREInfection ControlAntibiotic stewardshipRekha Murthy. Implementation of Strategies to Control Antimicrobial Resistance Chest 2001;119;405-当前第5页\共有49页\编4于1星1期五\9点理性回归/责任所在经验性抗感染治疗的基本原则耐药背景下的个体化治疗当前第页\共有49页\编于星期五\9点正确诊断是正确治疗的前提慢性咳嗽和黄痰-原因哮喘后鼻腔鼻漏病毒感染后气道高反应性胃酸返流吸烟相关的慢性支气管炎支气管扩张症弥漫性泛细支气管炎肺泡蛋白沉积症发热的诊断与鉴别诊断?急性发热-WBC不高/淋巴增高（无感染灶）－病毒！-WBC增高/中性粒增高/核左移－部位/病原体？－原发性菌血症？?慢性发热－IE、布病、慢性感染灶？结核病？－非感染性发热药物热、风湿病、恶性肿瘤－可能细菌！当前第页\共有49页\编于星期五\9点27-year-old man with acute lymphocytic leukemia.51-year-old man with chronic myelogenous leukemia.22-year-old woman with adult T- cell leukemia.67-year-old woman with adult T-cell leukemia.61-year-old man with interstitial fibrosis; patient was receiving chlorambucil for chronic lymphocytic leukemia.COP当前第页\共有49页\编于星期五\9点经验性治疗和目标治疗的统一SamplingIncluding invasive procedureswhen needed (BAL…)合格标本进行微生物学检查Rapid testsWhen available. Gram stain!!!开始经验性抗感染治疗Start adequate antibioti