重症肺炎抗感染治疗策略课件.pptVIP

Acinetobacter species. If Acinetobacter species are documented to be present, the most active agents are the carbapenems, sulbactam,colistin, and polymyxin 联合治疗是否能改善不动杆菌属感染的预后缺乏证据 ESBL-producing Enterobacteriaceae If ESBL Enterobacteriaceae are isolated, then monotherapy with a third-generation cephalosporin should be avoided. The most active agents are the carbapenems Methicillin-resistant Staphylococcus aureus. Linezolid is an alternative to vancomycin for the treatment of MRSA VAP This agent may also be preferred if patients have renal insufficiency or are receiving other nephrotoxic agents, but more data are needed 经验治疗无效常见原因 表现类似肺炎的非感染性疾病（如肺不张、肺栓塞、 肺出血或肿瘤等） 未知病原或耐药病原菌 不足量的抗菌药物治疗 并发肺外感染，脓胸、肺脓肿等并发症 谢 谢 ICU患者 β-内酰胺类药物（头孢噻肟，头孢曲松或氨卞西林/舒巴坦）联合阿奇霉素，或氟喹诺酮类药物（对青霉素过敏患者，推荐呼吸氟喹诺酮类药物和安曲南） 对社区获得性耐甲氧苯青霉素金黄色葡萄球菌（MRSA）感染，加用万古霉素或利奈唑胺 risk of MRSA infections admitted to ICUs should be screened by Microbiology / Infection control for MRSA colonisation ˇ?? ? ? Previous longterm antibioitic therapy, particularly intravenous therapy.? ˇ?? ? ?Previous admission to an ICU? ˇ??????Admission from a high risk source (long term care facility or nursing home)? ˇ??????Long-term open skin lesions ICU患者—假单胞菌属感染 对假单胞菌属感染，使用抗肺炎链球菌、抗假单胞菌活性的β-内酰胺类药物（哌拉西林/三唑巴坦、头孢吡肟、亚胺培南或美罗培南）联合环丙沙星或左氧氟沙星（750mg剂量） 或者上述β-内酰胺类药物同时联合氨基糖甙类和阿奇霉素 或者上述β-内酰胺类药物同时联合氨基糖甙类和抗肺炎球菌的氟喹诺酮类（对青霉素过敏患者，用氨曲南替代上述β-内酰胺类药物） Risk factors for Pseudomonas infection Pulmonary comorbidity (chronic structural illnesses such as GOLD-stage IV COPD, bronchiectasis, cystic fibrosis) Hospital admission of longer than 48 hours within the previous 30 days but not in the 7 days preceding the appearance of signs of pneumonia Glucocorticoid therapy (minimum of 10mg prednisolone or equivalent daily over at least 4 weeks) Broad-spectrum antibiotic therapy over more than 7 days within the last 3 month 对于通过急诊室入院的患者，在急诊室时就应该给予抗生素治疗 一旦获得可靠的CAP病原学证据，直接进行针对病原体的抗生素治疗 Woodhead M，et a1．Eur Respir J，2005，26：1138 抗菌素疗程 抗菌素治疗至少5天 体温正常48-72小时 各项指标基本恢复正常