抗菌药物应用的与策略精品.pptVIP

* 改善抗菌药物应用的方法 被动教育临床医生 限制抗菌药物应用 — 药物订单 — 处方集限制 — 审批制度 药品替换或更改 各科室药物应用评估 (DUE) 实行反馈制度以改善抗菌药物处方模式 计算机辅助医嘱录入系统 12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults Step 5: Practice antimicrobial control * 计算机辅助医嘱录入系统(Computerized Antimicrobial Decision Support) 依据当地资料制订计算机辅助决策系统 7年期间62,759例 患者接受抗菌药物治疗 1988 1994 医疗病例组合指数(CMI) 1.7481 2.0520 医院病死率 3.65% 2.65% 每例患者抗生素费用 $122.66 $51.90 围术期抗生素给药时机恰当 40% 99.1% 抗生素耐药性稳定 药物不良事件降低 30% Source: Pestotnik SL, et al: Ann Intern Med 1996;124:884-90 12 Steps to Prevent Antimicrobial Resistance: Hospitalized Adults Step 5: Practice antimicrobial control * 合理应用抗菌药物是一个复杂的系统工程，需要行政管理人员、临床医师、临床微生物工作者、临床药师、护理工作者和医院感染控制专业人员的共同认知、承诺与参与，不懈努力推动这项工作的实施，才能提高抗感染治疗水平 ，延缓耐药菌的产生！ * 谢 谢！ * * Bacteria have evolved numerous mechanisms to evade antimicrobial drugs. Chromosomal mutations are an important source of resistance to some antimicrobials. Acquisition of resistance genes or gene clusters, via conjugation, transposition, or transformation, accounts for most antimicrobial resistance among bacterial pathogens. These mechanisms also enhance the possibility of multi-drug resistance. * Once resistant strains of bacteria are present in a population, exposure to antimicrobial drugs favors their survival. Reducing antimicrobial selection pressure is one key to preventing antimicrobial resistance and preserving the utility of available drugs for as long as possible. * Once antimicrobial therapy is started, it is often difficult to stop, even when there is no indication for ongoing treatment. However, in some cases, unnecessary antimicrobial treatment may actually harm patients and add to treatment costs. * This randomized unblinded clinical trial of patients in a Veteran’s Administration Medical Center was designed to assess a pragmatic approach to use of antimicrobials in the ICU. Eligible patients had new-onset pulmonary infiltrate and a low clinical pulmonary infection score (CPIS = 6), indicati