重症感染的抗生素治疗策略 ppt课件

Antibiotic Therapy in ICU Ι Bin Du
美国ICU分离的革兰阴性菌
Neuhauser MM, Weinstein RA, Rydman R, et al. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA 2003; 289: 885-888
重症感染的抗生素治疗策略
Antibiotic Therapy in ICU Ι Bin Du
Antibiotic Therapy in ICU Ι Bin Du
利益冲突
• AstraZeneca • Aventis Sanofi • Eli Lilly • GlaxoWellcome • MSD • Pfizer • Squibb
Antibiotic Therapy in ICU Ι Bin Du
医院获得性血行性感染: EUROBACT
Tabah A, Koulenti D, Laupland K, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012; 38: 1930-1945
抗生素耐药机制
Antibiotic Therapy in ICU Ι Bin Du
Antibiotic Therapy in ICU Ι Bin Du
抗生素耐药机制: 一个古老的问题
D’Costa VM, King CE, Kalan L, et al. Antibiotic resistance is ancient. Nature 2011; 477: 457-461
1,417个ICU 共计10,038名患者 4,501名患者(45%)罹患感染
Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA 1995; 274: 639-644
• The most significant COI is that I am not a believer of evidencebased medicine
Antibiotic Therapy in ICU Ι Bin Du
ICU患者的重症感染: EPIC
1992年4月28-29日 17个国家
Antibiotic Therapy in ICU Ι Bin Du
抗生素耐药现状
National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32: 470-485
Antibiotic Therapy in ICU Ι Bin Du
ICU患者的重症感染: EPIC II
2007年5月8日 75个国家
1,265个ICU 共计13,796名患者 7,087名患者(51%)罹患感染
Vincent JL, Rello J, Marshall J,wenku.baidu.comet al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 302: 2323-2329
Antibiotic Therapy in ICU Ι Bin Du
医院获得性血行性感染: EUROBACT
Tabah A, Koulenti D, Laupland K, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012; 38: 1930-1945
Antibiotic Therapy in ICU Ι Bin Du
抗生素耐药机制: 一个古老的问题
结论 抗生素耐药是一种自然现象，在抗 生素选择性压力之前业已存在
D’Costa VM, King CE, Kalan L, et al. Antibiotic resistance is ancient. Nature 2011; 477: 457-461
Antibiotic Therapy in ICU Ι Bin Du
ICU患者的重症感染: EPIC II
革兰阳性球菌2,315 (46.8%) 革兰阴性杆菌3,077 (62.2%)
Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 302: 2323-2329