早期经验性抗生素治疗，多早算早.pptx

EarlyEmpiricalAntimicrobialTherapy:TheEarlier,TheBeter?Bin Du,MDMedicalICUPekingUnionMedicalCollegeHospital

ConflictsofInterestAstra ZenecaAventisSanofiBayerEli LillyGlaxoWelcomeMerckSharpeDomePfizerSquibb···

Infection-RelatedMortalityinChinaSummaryofInfectionEpidemiology*14.5%(280,752/1,938,430)ofalldeathsin2015Mortalitydataincalendaryearof2015obtainedfromtheNationalMortalitySurveillanceSystem(NMSS)whichcovers24.3%oftotalpopulationofChinawith605diseasesurveillancepointsSepsis-relatedmortalityidentifiedbyvalidatedICD-10codingsystemforinfectiousdiseases*Crudemortality84.49deathsper100,000population**Chinapopulation1,374,620,000in2015per 100,000 population1,055,708sepsis-related deaths**in2015

EarlyAppropriateEmpiricalAntibioticsPreBAL PostBALLunaCM,VujacichP,NiedermanMS,etal.ImpactofBALdataonthetherapyofoutcomeofventilator-associatedpneumonia.Chest 1997;111:676-685

EarlyAppropriateEmpiricalAntibioticstimefromhypotensiononset(hrs)KumarA,RobertsD,WoodKE,etal.Durationofhypotensionbeforeinitiationofeffectiveantimicrobialtherapyisthecriticaldeterminantofsurvivalinhumansepticshock.CritCareMed2006;34:1589-1596

AntimicrobialTherapyforSevereSepsisWerecommendthatadministrationofIVantimicrobialsshouldbeinitiatedassoonaspossibleafterrecognitionandwithinONEHOURforbothsepsisandsepticshock.strongrecommendation,moderatequalityofevidenceWe recommend empiric broad-spectrum therapywith one or moreantimicrobialsforpatientspresentingwithsepsisorsepticshocktocoverALLLIKELYPATHOGENS(including bacterial and potentialyfungalorviralcoverage).strong recommendation,moderate quality of evidenceRhodesA,EvansLE,AlhazzaniW,etal.Survivingsepsiscampaign:internationalguidelinesformanagementofsepsisandseptic shock:2016.Intensive Care Med 2017;43:304-377

DoesEachHourRealyCount?FICTION?SingerM.Antibiotic