血培养-临床医生应该知道什么绪论.pptx

血培养: 临床医生应该知道的 北京协和医院 杜 斌 Conflicts of Interest Speaker fee or consultation fee from the following pharmaceutical companies GSK Eli lilly Pfizer Sanofi-Aventis Xi’an Jasen MSD Bayer Wyeth 危重病患者的全身性感染 Brun-Buisson C, Doyon F, Carlet J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units; French ICU Group for Severe Sepsis. JAMA 1995; 274: 968- 974 血行性感染: 概述 在医院获得性感染中所占比例逐渐增加 ～ 200,000例血行性感染/年 病死率40 – 50% 血行性感染的致病菌 分离株比例 致病菌 美国1 芬兰2 凝固酶阴性葡萄球菌 31.9% 31% 金黄色葡萄球菌 15.7% 11% 肠球菌 11.1% 6% 念珠菌属 7.6% 4% 大肠杆菌 5.7% 11% 克雷白菌属 5.4% 5% 肠杆菌属 4.5% 3% 假单胞菌属 4.4% 5% 沙雷氏菌属 1.4% 草绿色链球菌 1.4% 5% Michael B. Edmond, Sarah E. Wallace, Donna K. McClish, et al. Nosocomial Bloodstream Infections in United States Hospitals: A Three-Year Analysis. Clin Infect Dis 1999; 29: 239-44. Lyytikainen O, Lumio J, Sarkkinen H, et al. Nosocomial Bloodstream Infections in Finnish Hospitals during 1999–2000. Clin Infect Dis 2002; 35: e14-9 血培养: 临床意义 Perez A, Herranz M, Segura M, et al. Epidemiologic impact of blood culture practices and antibiotic consumption on pneumococcal bacteraemia in children. Eur J Clin Microbiol Infect Dis 2008; 27: 717-724 Navarre vs. Majorca (2000 – 2004) Occult bacteraemia RR 11.8 (4.7 – 29.7) Bacteraemic pneumonia RR 2.6 (1.5 – 4.4) Meningitis RR 0.8 (0.2 – 2.8) 血培养: 临床意义 2002 2003 2004 Navarre Amox 376 358 385 Amox/Clav 370 366 356 Oral Ceph 277 268 240 Clari 97 82 70 Azi 225 208 169 Majorca Amox 383 363 365 Amox/Clav 387 400 428 Oral Ceph 420 412 347 Clari 145 140 111 Azi 241 230 206 Perez A, Herranz M, Segura M, et al. Epidemiologic impact of blood culture practices and antibiotic consumption on pneumococcal bacteraemia in children. Eur J Clin Microbiol Infect Dis 2008; 27: 717-724 内容 菌血症的危险因素 年龄 ? 30岁 OR 2.07 95% CI 1.19 – 3.60 心率 ? 90 bpm OR 1.90 95% CI 1.13 – 3.17 体温 ? 37.8?C OR 2.42 95% CI 1.41 – 4.14 白细胞计数 ? 12,000/?L OR 2.40 95% CI 1.41 – 4.10 应用中心静脉插管 OR 1.89 95%