AM1_IAI-腹腔內感染之治療.pptxVIP

Progress in cIAI Treatment;Intra-abdominal Infections (IAI)The Challanges;Surgery—MOST IMPORTANT  Therapeutic Modality “If surgery fails, all supporting non-operative measure will fail, and the patient may die” Dietnar H. Wittman, MD, PhD;Proper Procedures for Adequate Source Control of IAI?;When Should Antimicrobial Therapy Be Initiated for IAI?;Common Pathogens Residing in GI Tract;;Most Commonly Isolated Pathogens;Microbiology of IAIcommunity-acquired vs. healthcare-acquired;Community-acquired infections Enteric GNB, facultative bacilli, and β-lactam-susceptible GPC, obligate anaerobic bacilli (distal small-bowel and colon-derived infections and for more proximal perforations when obstruction is present) E coli, B fragilis Healthcare-associated infections (post-op/nosocomial) Prolonged pre-op LOS or 2 days pre-op antibiotics Usually more resistant flora Pseudomonas, Enterobacter and Proteus spp, MRSA, Enterococci, Candida spp Local epidemiology critical;IAIis usually polymicrobial infection;;Cultures? (1);Cultures? (2);Cultures? (3);Microbiology Results to Guide Antimicrobial Therapy?;In nosocomial infections, there is an increasing prevalence of resistant Enterobacteriaceae ESBL-producing E. coli/K. penumoniae Previous fluoroquinolone or cephalosporin use is risk factor Treatment failure observed with cephalosporins or β-lactam/β-lactamase inhibitor combination Increasing quinolone-resistance in ESBL-producing isolates Increasing prevalence of Bacteroides fragilis-resistant to clindamycin, cefotetan, cefoxitin and quinolones;;;;;;;;;Clinical Evidence: The Efficacy and Safety of Tigecycline for the Treatment of Complicated Intra-AbdominalInfections: Analysis of Pooled Clinical Trial Data;Clinical Infectious Diseases 2005; 41:S354–67;Clinical cure rate, by baseline diagnosis, at test-of-cure visit.;Microbiological eradication at the test-of-cure visit ;Efficacy and Safety in Chinese Patients.;Tigecycline clinical cure rates compare