耐药的环境下的HAP抗菌治疗.pptVIP

耐药环境下的HAP抗菌治疗 Thanks! * * * * * 厄他培南因为抗菌谱与其他碳青霉烯类不同，不在本次PPT讨论之列 * * A nested case control study was performed to define the inpatients at risk of acquiring ARB colonization among those starting antibiotics. Seven hundred fifteen patients were included: 42 cases and 673 controls. Table 4 shows the main epidemiological and clinical variables in cases and controls. In the multivariate analysis (Table 5), the use of carbapenems, age of 70 years, HIV infection, and length of stay (LOS) of 16 days before enrollment remained significant predictors of subsequent acquisition of target bacteria when adjusting for other variables such as colonization pressure, age, sex, and comorbidities (McFadden R2, 0.68). * * 单一因素分析显示：与对照组相比，之前使用过碳青霉烯和喹诺酮类药物是发生嗜麦芽窄食单胞菌多重耐药的风险因子（P=0.006）。 * * * In total, 3713 rectal swabs were analyzed from 933 patients hospitalized more than 48 h in the 5 different wards during the 2-year period. Among the 933 patients, 195 (21%) had a detectable P. aeruginosa gastrointestinal carriage; 45 patients had P. aeruginosa digestive carriage at unit admission and were excluded. Among the 150 patients with hospital-acquired P. aeruginosa (16.9%), 112 had ISPA (12.6%) and 38 had IRPA (4.3%) digestive carriage. Target ARB were MRSA, VRE, and ciprofloxacin-resistant Pseudomonas aeruginosa (CR-PA). * * FIG. 1. Mean carbapenem use (DOT/1,000 PD) was significantly lower in hospitals that restricted (shaded bars) versus did not restrict (open bars) carbapenems (P 0.04). Incidence rates of carbapenem-resistant P. aeruginosa (number of isolates/1,000 discharges) were lower for hospitals that restricted (dashed line) versus did not restrict (solid line) carbapenems (P 0.01). * * * * 在这张图上，横坐标是舒巴坦的浓度，纵坐标是被抑制的不动杆菌累计比例。 我们可以看到，随着舒巴坦浓度的增加，被抑制的不动杆菌累计比例也逐渐升高，敏感性可达60-100%。 这说明，舒巴坦具有内源性抗菌活性，可以直接抑制不动杆菌。 GRE Glycopeptide resistant Enterococcus S.pneumoniae-肺炎链球菌 N. gonorrhoeae-淋球菌 反思重锤猛击从“猛击策略”到“适当初始治疗”和“降阶梯策略” 开始的广覆盖-对于重症感染 开始即使用广谱抗生素以覆盖所有可能致病菌 随后的降阶梯-48-72小时后 根据微生物