美罗培南治疗医院获得性肺炎的理想之选.ppt

* Diagn Microbiol Infect Dis. 2005 Aug;52(4):317-22. In vitro synergy test of meropenem and sulbactam against clinical isolates of Acinetobacter baumannii. Kiffer CR， Sampaio JL， Sinto S， Oplustil CP， Koga PC， Arruda AC， Turner PJ， Mendes C. Source Advisory Group on Antimicrobials and Clinical Microbiology， Fleury Institute， 04344-070 Jabaquara-Sao Paulo-SP， Brazil. carlos.kiffer@.br Abstract Meropenem and imipenem are often the drugs of choice for the treatment of infections due to multidrug-resistant Acinetobacter baumannii. The present study aimed at evaluating the interaction between meropenem and sulbactam through microdilution and checkerboard methods against 48 clinical isolates of A. baumannii collected from Brazilian hospitals. All the isolates presented elevated minimum inhibitory concentration (or=2 microg/mL) to either meropenem or sulbactam. The checkerboard method with the combination of meropenem and sulbactam demonstrated 29.2% (14/48) synergism， 47.9% (23/48) partial synergism， 10.5% (5/48) additive， 6.2% (3/48) indifference， and 6.2% (3/48) antagonism (SigmaFIC(min)=0.09 and SigmaFIC(max)=8). Thus， combinations of meropenem and sulbactam may show synergism or partial synergism for most A. baumannii isolates. Further studies may help identify treatment options for patients with infections caused by these organisms， particularly with this combination， where both drugs have time-dependent activities and might be suitable for therapy optimization studies. 美罗培南治疗医院获得性肺炎的理想之选 2005年ATS指南明确了HAP的定义 ATS/IDSA.Am J Respir Crit Care Med. 2005;171:388-416. Ventilator Associated Pneumonia，VAP 气管插管48-72h后发生的肺炎，某些病情加重而需要插管的HAP患者，其处理与VAP相似 Health Care Associated Pneumonia，HCAP 最近90天内在急性护理医院住院时间≥2天；居住在护理之家或长期护理机构；近期接受静脉抗菌药物治疗、化疗或在近30天内接受过伤口护理；在医院或门诊部接受透析治疗 Hospital Acquired Pneumonia，HAP 患者入院后≥48h发生的肺炎 呼吸机 相关肺炎 医院获得 性肺炎 卫生保健 相关性肺炎 我国HAP发病率高，居医院感染首位 周锦桃等. 国际呼吸杂志. 2007;27(12)：936-939. 医院获得性 肺炎 HAP是最常见院内感染性疾病，约占医院感染的29.5% Text Text 国际上多数报道HAP 发病率为0.5%-1.0% 我国HAP发病率 为