何礼贤 MV-NGNB菌肺部感染.ppt

Attributable mortality of Stenotrophomonas maltophilia infections: a systematic review of the literature In 6 of 7 studies, mortality was significantly higher in cases than controls in 6 of these studies; it was lower in cases than controls in the one study where controls had Pseudomonas aeruginosa bacteremia. In 3 of 4 studies providing relevant data, mortality of cases treated with inappropriate initial antibiotic treatment was significantly higher compared with cases treated with appropriate initial antibiotic treatment. Conclusion: A considerable mortality rate (up to 37.5%) can be at tributed to S. maltophilia infection. Thus, clinicians should not underestimate the clinical significance of S. maltophilia Future Microb2009,4(9):1103 呼吸道分泌物分离出S.malt需要治疗吗？ 原则：治疗感染，不是治疗分离菌 提倡：合格标本定量或半定量培养； 临床意义：参考标本来源 ?BALFEATSputum 充分结合临床： ?感染证据 ?影像学表现：VAP 必须治疗 VAT 参考细菌浓度 S maltophilia 治疗药物 TMP-SMX Minocycline Ticarcillin-Clav.+Aztreonam Meropenem Respiratory quinolones, or Colistin/Polymyxin Burke A Cunha, ? ... Bacterial Infections Updated: Oct 19, 2009 S maltophilia感染推荐治疗 Some experts recommend coverage with TMP/SMX plus ticarcillin/clavulanate due to concern for resistance. Multiply-resistant: colistin 2.5 mg/kg?q12h IV. Remove catheter in catheter-related bacteremia. Treatment duration uncertain, but usually 14d. John G. Bartlett, M.D. 03-26-2009 ABX 2010年中国CHINET细菌耐药性监测 2011；11（5）:321-329 国内部分文献：S.mal肺炎的治疗 报告者 发表 临床和细菌学情况 治疗 疗效 备注 李媛，等. Zggryhlzz 重症肺炎13例。P.a 5,A.baum 3, 头孢哌酮舒- 临床：69.2% S.mal 2, 清 2001,1:46 S.mal 2, k.pn.2… 舒巴坦 细菌：53.8% 除1株 潘发愤,等。 Zhyygrxzz 医院内 S.mal下呼吸道感染65例；联合治疗 痊愈：53.8% 2001,11:409 抗生素敏感率：PIP/T 91%,CPZ/S 好转: 23.1% 84%,TBM77%, SMZ/TMP 69%,