大力加强抗菌药物临床应用管理讲解课件.ppt

* In a 1998 meta-analysis of 28 prospective studies (N=9,478) comparing single- and multiple-dose surgical prophylaxis in major surgery, McDonald and colleagues found no additional benefit of multiple doses of antibiotics in the prevention of SSIs. The combined OR for single-dose vs multiple-dose by the fixed-effects model was 1.06 (95% CI, 0.89–1.25), and was 1.04 for the random-effects model (95% CI, 0.86–1.27).1 Whereas a number of the studies included in this meta-analysis had small sample sizes, a series of fixed-effect validation analyses confirmed the validity of the group’s conclusions.1 Reference: 1. McDonald M, Grabsch E, Marshall C, Forbes A. Single- versus multiple-dose  antimicrobial prophylaxis for major surgery: a systematic review.  Aust NZ J Surg. 1998;68:388–396. * Harbarth and colleagues performed an observational 4-year cohort study involving 2,641 patients at a tertiary-care center who had undergone coronary artery bypass grafting (CABG). The results showed that prolonged antibiotic prophylaxis (48 hours) was not associated with a decreased risk of SSI (adjusted odds ratio [OR], 1.2; 95% confidence interval [CI], 0.8–1.6) compared with a short (48 hours) course. Furthermore, prolonged antibiotics were correlated with an increased risk of acquired antibiotic resistance (adjusted OR, 1.6; CI, 1.1–2.6).1 Multivariate analysis identified 4 variables that increased the risk of acquired-resistance Enterobacteriaceae or enterococci:1 Antibiotic prophylaxis for 48 hours (OR, 1.6; P=0.027) Age 65 years (OR, 1.3; P=0.022) Combined CABG/valve surgery (OR, 2.7; P=0.002) Post-CABG antibiotic therapy (OR, 1.8; P=0.054) Reference: 1. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic  prophylaxis after cardiovascular surgery and its effect on surgical site  infections and antimicrobial resistance. Circulation. 2000;101:2916–2921. 选择抗感染治疗方案，必须遵循抗感染治疗的基本原则，首先考虑控制感染，而不是控制DDD数。 * 正确的经验性治疗，可以避免初始治疗失败导致的疗程延长、抗菌药物使用总量增加。 * 正确的经验性治疗，