重症医生在控制多重耐药菌(MDR)感染中的作用-胡振杰.pptVIP

重症医生在控制多重耐药菌(MDR)感染中的作用 河北医科大学第四医院ICU 胡振杰 重症医生在控制MDR感染中的作用 多重耐药菌(MDR)感染及其危险因素； MDR in ICU— HAI的风口浪尖； 重症医生应对多重耐药菌(MDR)感染的措施； 重症医生在控制MDR感染中的作用 多重耐药菌(MDR)感染及其危险因素； MDR in ICU— HAI的风口浪尖； 重症医生应对多重耐药菌(MDR)感染的措施； ICU中严格的感染控制措施就能够控制 MDR感染? 重症医生在控制MDR感染中的作用 多重耐药菌(MDR)感染及其危险因素； MDR in ICU— HAI的风口浪尖； 重症医生应对多重耐药菌(MDR)感染的措施； 重症感染、感染性休克相关概念 重症患者及相关感染概念(ACCP/SCCM) Sepsis(全身性感染、脓毒症)=感染+SIRS； Septic shock(感染性休克)=Sepsis + 血流动力学改变； Severe sepsis(严重感染)：Sepsis + 器官功能障碍； MODS的诊断可以理解为：SIRS or Sepsis + 2个以上器官功能障碍； 应对多重耐药菌(MDR)感染的措施 应对MDR感染的非抗生素防治策略： 抗生素相关策略---合理、规范使用抗生素； 1. Effective infection control measures: staff education, compliance with alcohol-based hand disinfection, and isolation to reduce cross-infection with MDR pathogens should be used routinely (Level I) . 2. Surveillance of ICU infections, to identify and quantify endemic and new MDR pathogens, and preparation of timely data for infection control and to guide appropriate, antimicrobial therapy in patients with suspected HAP or other nosocomial infections, are recommended (Level II) * 多重耐药菌(MDR)感染及其危险因素 Multidrug-resistant (MDR) bacterial pathogens, such as Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus(MRSA). Extendedspectrum-lactamase–producing Enterobacteriaceae. American Journal of Respiratory and CCM.2005;171:388-416 Antimicrobial therapy in preceding 90 d Current hospitalization of 5 d or more High frequency of antibiotic resistance in the community or in the specific hospital unit Presence of risk factors for HCAP: Hospitalization for 2 d or more in the preceding 90 d Residence in a nursing home or extended care facility Home infusion therapy (including antibiotics) Chronic dialysis within 30 d Home wound care Family member with multidrug-resistant pathogen Immunosuppressive disease and/or therapy 多重耐药菌(MDR)感染及其危险因素 RISK FACTORS FOR MULTIDRUG-RESISTANT PATHOGENS CAUSING HOSPITAL-ACQUIRED PNEUMONIA, HEALT