肿瘤合并粒细胞减少病人抗生素使用临床实践指南(中英对照版)精选.pptVIP

谢谢! 正在为2008年的最终版本而调整 * The Timeline of Fever and Neutropenia * 粒减伴发热的时间线 粒减伴发热 高危 低危 不明病因发热 证明的感染 持续发热 经验性 抗真菌 治疗 不明病因发热 证明的感染 * Gram-negative sepsis: Survival probability depends onappropriate initial therapy The inappropriate therapy group has the lower probability of survival than the appropriate therapy group. The 30-day mortality 27.4%, vs 38.4% (P = 0.049). Kang et al Antimicrob Agents Chemother. 2005; 49(2): 760–766. * 革兰氏阴性菌菌血症：适当初始治疗的存活率 不适当治疗组的存活率低于适当治疗组。30天死亡率27.4% VS 38.4%（P=0.049）。 Kang et al Antimicrob Agents Chemother. 2005;49(2):760-766 * * 单药治疗FN与联用氨基糖苷类存活率相同 头孢他啶疗效低于其他β内酰胺类抗生素头孢吡肟和哌拉西林他唑巴坦相当 Paul, M. et al. BMJ 2003;326:1111 Glasmacher A. et al Clin Micro ID 2005; 11(sup 5):17 * * 关于氟奎诺酮预防的3篇必威体育精装版文献 * Selected Use of Empiric AntifungalTherapy: Current Controversy Pizzo Am J Med 1982 -- Ampho B (n=18) vs none (n=16) EORTC Ann Intern Med 1989 (n=132) ???? 25 years later: ???? Anti-Candida prophylaxis routine in HSCT longer neutropenias (A-I) ???? Changing spectrum of IFIs ???? Improving diagnostic tools: CT, serum markers ???? Does fever alone indicate significant risk for IFI? ???? “Maintaining guidelines that dictate treatment of a population in which 90% of patients do not have invasive fungal disease is not justifiable….” De Pauw B. NEJM 2005;41:1251 * 经验性抗真菌治疗的选择：当前的争论 Pizzo Am J Med 1982—两性霉素B（n=18）VS none（n=16）EORTC Ann Intern Med 1989 （n=132） 25 年之后： 抗念珠菌属预防常规用于HSCT和长期粒减。（A-I） 侵袭性真菌感染（IFIs）病菌谱改变。 提高的诊断手段：CT，血清标志物 单独的发热是否是侵袭性真菌感染的指征？ “维持指南中认为90%的病人没有侵袭性真菌疾病的治疗指示是不合理的……” De Pauw B. NEJM 2005;41:1251 * Antifungal ProphylaxisHigh Risk cont’d Posaconazole has been shown to prevent Candida and Aspergillus, without impact on mortality, in patients undergoing treatment for GvHD and is recommended in this setting. (A-I) Ullmann AJ, et al. NEJM 2007;356:335-47 * 抗真菌预防：高危 泊沙康唑已被用于对正在治疗GvHD的病人预防念珠菌属和曲霉菌属的感染，对死亡率没有影响，并被推荐在此环境下使用。（A－I） Ullmann AJ, et al. NEJM 2007 ; 356:335-47 * Environmental Precautions No specific protective gear (gowns, gloves, m