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抗生素合理使用策略（英文PPT）Antibioticstewardship in the Acute and Community
* Alexander Fleming 1946: Plea for prudent use of Penicillin: Ensure infection amenable to antibiotics, send specimens to lab, ensure susceptibility, correct dose for short duration. A. Modifying patient risk factors for infection 3: Prevent surgical site infection ? Monitor and maintain normal blood glucose levels in surgical patients ? Maintain normothermia ? Perform proper skin preparation using appropriate antiseptic agent ? Avoid shaving the operative site A. Modifying patient risk factors for infection 4: Prevent hospital-acquired pneumonia ? Wean patients from ventilators when appropriate ? Drain ventilator breathing circuit condensate away from the patient ? For patients on ventilators, or with an enteral tube in place, elevate the head of the bed to 30-45o ? Prevent contamination of respiratory therapy equipment, ventilator circuits and respiratory medications B: Diagnose infection effectively 1: Use appropriate clinical diagnosis of infection ? Always assess and document the clinical signs/symptoms of infection ? Always assess and document: ? The likelihood of infection ? The likely source of infection ? The likely pathogen(s) B: Diagnose infection effectively 2: Use appropriate laboratory methods of diagnosis ? Order appropriate lab tests ? Obtain appropriate specimens ? If in doubt, contact your laboratory service for advice ? Always follow up on laboratory results and take appropriate action, where required C: Treat infection wisely 1: Get expert advice ? Consult a clinical microbiologist or infectious disease physician when dealing with complex infections ? For infections requiring drainage or debridement consult a surgeon or interventional radiologist C: Treat infection wisely 2: Use surgical antibiotic prophylaxis wisely ? Give the first dose within 1 hour prior to incision ? Use appropriate antimicrobial agent and dose ? Repeat dose during prolonged surgery, if needed to maintain blood levels ? Most procedures only need one dose ? Discontinue
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