课件：经验性抗感染治疗.ppt

b内酰胺类抗生素与庆大霉素或氟喹诺酮类抗菌药物体外联合后均略可提高铜绿假单胞菌的敏感率，但庆大霉素的增效作用略强于氟喹诺酮类， Twenty-eight days after the onset of VAP, 18.8% of the 197 patients in the 8-day group and 17.2% of the 204 patients in the 15-day group died (no statistical significance). For recurrence, there was no difference between the two regimens. However, for primary infections caused by nonfermenting GNB, a higher percentage of patients developed documented pulmonary infection recurrence in the 8-day group than in the 15-day group. The patients who received 8 days of therapy had significantly more mean antibiotic- free days and significantly more broad-spectrum antibiotic-free days. Multiresistant pathogens emerged more frequently for patients with pulmonary infection recurrence who had received 15 days of antibiotics. The authors concluded that among patients who had received appropriate initial empiric therapy, with the possible exception of those developing gram-negative bacillus infections, comparable clinical effectiveness against VAP was obtained with the 8-day and 15-day treatment regimens. The 8-day group had less antibiotic use. Bacteria have evolved numerous mechanisms to evade antimicrobial drugs. Chromosomal mutations are an important source of resistance to some antimicrobials. Acquisition of resistance genes or gene clusters, via conjugation, transposition, or transformation, accounts for most antimicrobial resistance among bacterial pathogens. These mechanisms also enhance the possibility of multi-drug resistance. Once resistant strains of bacteria are present in a population, exposure to antimicrobial drugs favors their survival Reducing antimicrobial selection pressure is one key to preventing antimicrobial resistance and preserving the utility of available drugs for as long as possible * Infectious diseases specialists are one important resource for providing input, but many other professionals also contribute to optimal care for patients with infections Like all patient safety end