细菌耐药趋势及合理使用抗菌药物的策略 [兼容模式] [修复的].ppt

忠告 没有一种抗生素能完全避免耐药问题 尽量减少不必要的使用 尽量避免使用高选择性的品种（附加损害） 使用抗生素不能取代良好的感染控制措施 * Thank you - a delight to be here – share some of the experiences of our group on antibiotic resistance. * In clinical practice, antimicrobial resistance has become a major concern, as several studies have found that it is associated with increased length of hospital stay, increased mortality as well as increased cost. With antimicrobial resistance varying from country to country, it is important to consider local resistance pattern when prescribing antibiotics for initial or empirical therapy. This issue is of particular importance in some Asian countries with high resistance rates among respiratory pathogens. * 本图是美国纽约州Buffalo地区Millard Fillmore医疗系统1980-1995年间头孢菌素用量与MRSA分离率的关系统计结果。 图表中的实线显示的是头孢菌素用量的走势图，虚线显示的是MRSA分离率的走势图。左侧Y轴显示头孢菌素用量，右侧Y轴显示MRSA分离率。 从图中可以看到：81年--- 87年头孢菌素用量上升，82年开始到88年MRSA的分离率也达到高峰，几乎是82年的十倍。 87年– 91年限制头孢菌素使用后头孢菌素用量下降，89年—93年MRSA 的分离率也随之下降。 而当91年后头孢菌素用量又一次上升是，MRSA的分离率也又一次最之上升。 由此可见：MRSA的发生率与头孢菌素的用量密切相关，呈正相关 * Slide * Rahal and colleagues demonstrated that a restriction of third-generation cephalosporin use was followed by a reduction in the frequency of isolation of ESBL-producing K. pneumoniae by 44% overall (a 70.9% reduction within all ICUs, and an 87.5% reduction in the surgical ICU). Restriction of ceftazidime, cefotaxime, and ceftriaxone was accomplished by requiring approval by an infectious disease physician. To reduce the use of third-generation cephalosporins (measured in grams), a carbapenem was selected as a replacement therapeutic agent. The result was an increase in the use of imipenem as measured in grams (+141%). The absolute number of patient-related ceftazidime-resistant Klebsiella isolates decreased from 150 in 1995 to 84 in 1996. However, there was also an unintended consequence, as shown by a 68.7% increase in the incidence of imipenem-resistant P. aeruginosa. * 制定恰当的抗菌治疗方法时，传统问题常常关注于临床和细菌学有效性以及安全性。但是，随着全世界范围内抗生素耐药菌株的不断增加，应当再添加一个问题，这个问题与称作“附加损害”的影