mrsa 感染治疗mrsa感染治疗 感染治疗.ppt

合理使用抗生素 不针对“定植”治疗 治疗肺炎，而非气管插管 治疗泌尿道感染，而非弗利氏导尿管 治疗菌血症，而非导管尖端 治疗骨感染，而非皮肤菌群 合理使用抗生素 “见好就收” 适时停用抗生素 感染未得到诊断 感染可能性非常小 培养阴性 观点之三 控制MRSA是十分迫切的工作，临床医师必须转变观点。贯彻院内感染防控措施亟待加强。 积极而又理智地应用抗生素包括MRSA药物。在有危险因素患者需要早期、充分和最有效的药物，而在一旦证明不是MRSA感染时应尽早停药，勇敢地冲锋和聪明地退却都是胜利。 总 结 MRSA新的流行学特点和发展趋势要求临床高度重视，及早诊断和治疗。 抗MRSA药物的选择需要参考多种因素。利奈唑胺作为抗MRSA的新药，具有现用药物所没有的多种优势。 加强MRSA防控和治疗同样甚至更重要，其中也包括合理用药。 * * PCR培养MRSA所需的时间：4小时，可以早期治疗 * * * * Impact of Inappropriate Initial Empiric Antibiotic Selection Key Points: Multiple studies indicate that inappropriate initial therapy negatively impacts survival in patients with serious infections Definition of inappropriate antimicrobial therapy (according to ATS/IDSA)5: The use of an agent or agents to which the isolated pathogens are later determined to be non-susceptible Some studies use the term “inadequate therapy” to describe the same situation Supplemental Information: Ibrahim et al conducted a prospective cohort study between 1997 – 1999 in medical intensive care units (ICUs) of US urban teaching hospitals. Adequacy of antimicrobial treatment was determined for patients with bloodstream infections (n = 492)1 Inadequate antimicrobial treatment was defined as not effectively treating the pathogen causing the infection at the time susceptibility was identified. Inadequate therapy included the absence of antimicrobial agents directed at a specific class of microorganisms and the administration of a drug to which the microorganism responsible was resistant Valles et al conducted a prospective multicenter study in 30 ICUs in Spain in both 1993 and 1998. Patients diagnosed with CA bloodstream infections (n = 339) were evaluated for inappropriate therapy and outcomes2 Inappropriate therapy was defined as not effectively treating the infection at the time the infecting pathogen was identified and susceptibility was known Khatib et al conducted a prospective surveillance study between January 2002 and June 2003 in a Detroit teaching hospital. Patients diagnosed with