急性呼吸衰竭抗生素的使用（英文PPT）Antibioticsin Acute Respiratory .ppt

Viral Identification 2007 – Pretoria Academic Hospital Bronchiolitis in HIV positive children 12% of bronchiolitics at PAH are HIV positive Mean age 8 months old (vs 3 months in non HIV-infected children) No increase in numbers co-infected in more mild disease Pearson correlation r = 0.138 Summary CAP = Ampicillin +/- HAP = Meropenem +/- PCP = Bactrim + oral steroids + Ganciclovir Bronchiolitis = nothing ? Using this policy and noting that all HIV-infected children are offered ventilation if required – Mortality in PICU at PAH = 18.7% Aknowledgement Dr Refiloe Masekela Dr Omolemo Kitchin Dr Teshni Moodley Dr Sam Risenga Prof Max Klein * Prednisone is as important in Paediatric PCP as it is in adults. This study conducted by Dr Terblanche in my Unit at Pretoria Academic Hospital reveals that children who received prednisone had a 54% better survival chance More resistant organisms are cultured from ICU patients Those strategies underlined are the ones we use at Pretoria Academic Hospital PICU CRP and WCC do not correlate in diagnosing viral/bacterial origin of disease in infants with bronchiolitis Common Community acquired organisms are found in ward patients with pneumonia. However HIV-infected children may harbour resistant organisms * Antibiotics in Acute Respiratory Failure Robin J Green PhD Division of Paediatric Pulmonology University of Pretoria Definitions ALI- acute onset of impaired gas exchange PaO2/FIO2 300 ARDS- PaO2/FIO2 200 Oxygenation index=( MAP x FI02/Pao2)x100 Acute Lung Injury CAP HIV-associated pneumonia HAP/VAP Viral lung disease Definition Community Acquired Pneumonia Acute infection (less than 14 days) acquired in the community, of the lower respiratory tract, leading to cough or difficulty breathing, tachypnoea or chest-wall indrawing Accounts for 30-40% of all hospital admissions Case fatality rate 15-28% Zar HJ, et al SAMJ 2005 Causes Community Acquired Pneumonia Bacterial: - Strep Pneumoniae - Haemophilus influenzae - Staph aureus