抗菌药物合理应用(泌尿外科)zhengbo精品.pptVIP

前列腺炎—非典型致病菌与混合感染 夏邦世 慢性前列腺炎病原体分布及耐药性监测 Chin J Nosocomiol Vol. 16 No. 3 2006 N=312 非典型致病菌检出率为23.7%，其中15.1%合并细菌感染 非典型病原体 第四代喹诺酮莫西沙星抗菌特点 抗生素 抗菌谱及抗菌活性 G-菌 G+菌 厌氧菌 非典型病原体 结核杆菌 第一代喹诺酮 ? － － － － 第二代喹诺酮 ? ? － － － － 第三代喹诺酮 ? ? ? ? ? 第四代喹诺酮 （莫西沙星） ? ? ? ? ? ? ? ? ? 第三代头孢菌素 ? ? ? ? － － 大环内酯 － ? ? － ? ? － 氨基糖苷类 ? ? － － － － 前列腺组织穿透力强 Journal of Chemotheory,2006,18:485-489. Eur Urol Suppl 2006;5(2):249 合理选择抗菌药物是治疗的关键 药物特点--高敏感性及高组织浓度 选药标准--脂溶性、穿透能力强并在前列腺组织达到有效浓度，如喹诺酮类药物。 美国主要选择喹诺酮类药物（60%），其次是磺胺类药物（24%）。 前列腺炎--合理选择抗生素 细菌 患者 毒性 药代动力学 药效动力学 防御功能 感染 耐药 抗菌治疗三角 抗菌药物 总结 根据流行病学和临床资料估计可能病原体，应重视细菌培养。 根据病情严重程度、当地药敏资料选择合适的抗菌药物。 根据喹诺酮类药物PK/PD特性及患者生理状况合理安排治疗方案。 谢 谢 郑波 北京大学临床药理研究所 doctorzhengbo@163.com * In 1945, a few years after Penicillin was introduced to the world, Fleming created a strain of Staphylococcus aureus that was resistant to penicillin. This was accomplished by exposing s. aureus to sub-optimal doses of Penicillin. Fleming warned the world about antibiotic resistance during an interview with the New York Times. Between 1945 and 1955, Penicillin was available to the public over the counter, without a prescription. During those ten years the public did in vivo what Fleming did in vitro: People stopped taking PCN as soon as they began to feel better, they took PCN for viral infections, some reports even say PCN was used to treat male pattern baldness… * * * SAM:氨苄西林/舒巴坦 CXM:头孢呋辛 CRO: 头孢曲松 FEP:头孢吡肟 * In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care. A mean of 56% of body sites and 17% of environmental sites were VRE positive. After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE. After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated. The inanimate environment plays a role in facilitating transmission of organisms. * This iceberg graphically represents colonization versus