糖尿病足溃疡感染的抗生素治疗冉兴无课件.ppt

* * * *INVANZ? (ertapenem sodium) is indicated for the treatment of moderate to severe complicated skin/skin structure infections, including diabetic foot infections without osteomyelitis, due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus agalactiae, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Bacteroides fragilis, Peptostreptococcus species, Porphyromonas asaccharolytica, or Prevotella bivia. INVANZ has not been studied in diabetic foot infections with concomitant osteomyelitis. Piperacillin/Tazobactam (Zosyn) is indicated for the treatment of moderate to severe complicated and uncomplicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by piperacillin-resistant, beta-lactamase producing strains of Staphylococcus aureus.1 INVANZ is a registered trademark of Merck Co., Inc. Zosyn is a registered trademark of Wyeth Pharmaceuticals. Reference: 1. Zosyn [package insert]. Philadelphia, Pa: Wyeth Pharmaceuticals; 2004. * * * * * 抗生素选择原则（一） 抗生素的经验治疗应依据感染程度和可能的病原菌选择抗生素(B-II). 对最近未使用过抗生素的轻中度感染患者，通常仅需要针对革兰氏需氧球菌用药 (A-II). 没有必要常规地使用广谱抗生素进行经验性治疗，但对重度感染的患者，要依据培养结果和药敏试验选择使用广谱抗生素 (B-III). 必须考虑患者最近使用过的抗生素和本地的抗生素药敏报表，尤其需要考虑耐药菌株的情况如 MRSA. Lipsky BA et al. Clin Infect Dis. 2004;39:885–910. 抗生素选择原则（二） 确切的抗生素治疗必须建立在细菌培养结果、药敏试验的基础上，尤其是经验治疗的临床反应。 (C-III). 避免对未感染的溃疡使用抗生素，现有的证据不支持对无临床感染的溃疡进行抗生素治疗 （破坏皮肤正常菌群、引起耐药和条件致病菌的入侵）(D-III). 对清创后溃疡组织菌落计数 ≥106 CFU/g 或有?-溶血链球菌，可以局部使用抗生素以降低溃疡面的细菌水平. 一旦达到菌群平衡，要停止局部使用抗生素，减少抗生素可能的细胞毒性作用和耐药菌株的发生 (Level I) Lipsky BA et al. Clin Infect Dis. 2004;39:885–910. 抗生素使用的方式与疗程 Lipsky BA et al. Clin Infect Dis. 2004;39:885–910. 未危及肢体的感染的处理 Frykberg RG. An evidence-based approach to diabetic foot infections. Am J Surg. 2003 ;186(5A):44S-54S; discussion 61S-64S. 未危及肢体的感染抗菌治疗（经验用药） Frykberg RG. An evidence-based approach to diabetic foot infections. Am J Surg. 2003 ;186(5A):44S-54S; discussion 61S-64S. 危及肢体的