呼吸及其他-碳青霉烯治疗多重耐药非发酵细菌感染的策略详解.ppt

* * * This slide illustrates comparisons of hospital costs and length of stay in patients with resistant and sensitive Gram-negative rod (GNR) infections A retrospective analysis reanalyzed a previously defined cohort of 924 consecutive GNR infections occurring between December 1996 and September 2000 in a university hospital surgical ICU and ward [Evans/p89/col3] The analysis included 604 surgical patients with GNR infections [Evans/p90/col2] 467 sensitive and 137 resistant infections [Evans/p90/col2] Resistance was defined as resistance to all drugs in 1 or more of the following antibiotic classes: aminoglycosides, cephalosporins, carbapenems, and fluoroquinolones [Evans/p89/col3-p90/col1] Emergence of resistance was defined as subsequent detection of resistance to at least 1 class of antibiotics after previous isolation of the same GNR species without resistance [Evans/p90/col1] As compared with patients having sensitive GNR infections, patients with resistant GNR infections had: [Evans/p91/Table2] Higher median hospital costs ($80,500 vs $29,604; P0.0001) Higher median antibiotic costs ($2,607 vs $758; P0.0001) Longer median hospital length of stay (29 days vs 13 days; P0.0001) Longer median ICU length of stay (13 days vs 1 day; P0.0001) Reference 1. Evans HL, Lefrak SN, Lyman J, et al. Cost of gram-negative resistance. Crit Care Med. 2007;35:89-95. * Ref 1, Lawrence 2009, p 435, Fig 1 Antimicrobial stewardship is a multifaceted approach to improving antimicrobial use. The goals of antimicrobial stewardship include combating the emergence of bacterial resistance, improving clinical outcomes, and controlling costs. Ref 1, Lawrence, p 434, C1, ?1, 1-5 Reference Lawrence KL, Kollef MH. Antimicrobial stewardship in the intensive care unit. Advances and obstacles. Am J Respir Crit Care Med. 2009;179:434-438. * * A 3-year, prospective, controlled, quasi-experimental study was conducted in 3 ICUs for a 1-year period before a multifaceted infection control