重庆抗菌药物管理及合理应用要点.ppt

In 1929 Fleming said: The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Major Pathogens in SSI PK PD ADR ID ABR IM 个体化治疗！ WHO减少多重耐药菌感染 必威体育精装版一揽子计划 手卫生 接触隔离 减少设备共用 环境清洁 医院感染组合预防 --呼吸机相关肺炎 --导管相关血流感染 --导尿管相关尿路感染 主动监测培养 鼻拭子MRSA 大便 VRE 洗必泰洗浴 抗菌药物合理使用与管理 责无旁贷 抵御抗菌药物耐药 维护患者和子孙后代利益 药物研发生产单位的要求 医院的地位、作用和责任 高度重视 社会 共识 强化抗菌药物管理 结 语 感染 预防比治疗更重要 感染从发生到治愈是一个充满变化的复杂过程 抗菌 疗效最大化与不良反应最小化 用药艺术 !! 没有哪个药可以解决所有感染问题 We need to preserve antibiotics- a precious resource by working together Combating antimicrobial resistance: No action today, no cure tomorrow * * Therapy – individual or group treatment Metaphylaxis – The timely mass medication of a group of animals to eliminate or minimize an expected outbreak of disease. Prophylaxis – measures designed to prevent the occurrence of disease or its dissemination. Growth promotion, feed efficiency – at lower than treatment levels * 稳可信不同于其它抗生素，它具有独特的作用机制： 1.抑制细菌细胞壁的合成。其抑制作用在粘肽侧链形成的第二步，使细 菌不能生长繁殖，对繁殖期细菌具有快速杀菌作用。 2.损伤细菌细胞膜，改变细胞膜的通透性，破坏其屏障作用。 3.阻碍细菌RNA的合成，影响遗传信息的复制。 稳可信独特的杀菌作用机制使MRSA/MRSE对其没有耐药。 12 * * In clean surgical procedures in which the GI tract has not been entered, Staphylococcus aureus is the most common cause of infection.1 The most common infecting organisms in CRS, however, originate from the bowel lumen. By far, the most frequently isolated of these is the anaerobe Bacillus fragilis, while the most common aerobic member of the bowel flora is the gram-negative bacillus Escherichia coli.2 Other microbes may be seeded from a distant source, such as the skin or nares, or from an implant. These pathogens include S aureus, coagulase-negative staphylococci, Candida albicans,