关注细菌耐药性优化抗感染经验治疗

MRSAMRSAESBLsESBLsVREVRECDADCDADMDRMDRMDRMDRPrevalenceofAntimicrobial-Resistant(R)PathogensCausingHospital-OnsetIntensiveCareUnitInfections:1999versus1994-98Organism#Isolates%Increase*Flu-RPseudomonasspp.265749%3rdG-C-RE.coli155148%MRSA254640%VRE474440%IMP-RPseudomonasspp.183920%*PercentincreaseinproportionofpathogensresistanttoindicatedantimicrobialSource:NationalNosocomialInfectionsSurveillance(NNIS)SystemMRSAAmongICUPatients1995-20040102030405060701995199619971998199920002001200220032004YearPercentResistanceSource:NationalNosocomialInfectionsSurveillance(NNIS)SystemVREAmongICUPatients1995-2004051015202530351995199619971998199920002001200220032004YearPercentResistanceSource:NationalNosocomialInfectionsSurveillance(NNIS)System3rd-GRKAmongICUPatients1995-20040510152025301995199619971998199920002001200220032004YearPercentResistanceSource:NationalNosocomialInfectionsSurveillance(NNIS)SystemFQRPAmongICUPatients1995-200405101520253035401995199619971998199920002001200220032004YearPercentResistanceSource:NationalNosocomialInfectionsSurveillance(NNIS)System1602.72/32510%IDrelatedtoRes.Bugƒ-----ƒ:ƒƒ121110987654321999¾Linkto:IDSAguidelinesforevaluatingfeverincriticallyilladults0%10%20%30%40%50%Community-onsetinfectionHospital-onsetinfectionHospital-onsetinfectionafterinitialcommunity-onsetinfectionInappropriateAntimicrobialTherapy(n=655ICUpatientswithinfection)PatientGroup%inappropriate17.1%34.3%45.2%Source:KollefM,etal:Chest1999;115:462-74BSIEMPIRICAFTERCx+AFTERASTASSOC.MORT(%)RELATIVERISKAAA10.51.0IAA13.31.27AIA20.01.91AAI20.01.91IIA25.82.46AII28.62.73IAI0.0(2)0.05III33.33.18ClinInfecDis24:584-602,1997:ID:9ID5:Source:SchiffGD,etal:JtCommJQualImprov2001;27:387-402¾¾¾¾¾¾¾¾¾Linkto:SHEA/IDSA:GuidelinesforthePreventionofAntimicrobialResistance¾inHospitals¾¾¾Linkto:NCCLSProposedGuidanceforAntibiogramDevelopmentTMP/SMX*SanFranciscoGeneralHospitalMartinJN,etal:JInfectDis1999;180:1809-18010203040506019881989199019911992199319941995%ResistantPatient-IsolatesNon-HIVunits(n=28,966patient-isolates)HIVunits(n=1,920patient-isolates)PrevalenceofTMP/SMXuseamongAIDSpatients*30,886patient-isolatesStaphylococcusaureusEscherichiacoliEnterobacterspp.KlebsiellapneumoniaeMorganellaspp.Proteusspp.Serratiaspp.Citrobacterspp.01020304050HIV/AIDSTraumaCOPDDiabetesDialysisHomelessInjectionDrugUsePediatricPatientCharacteristicsPercentResistantPatient-isolatesSanFranciscoGeneralHospital1996-1997¾¾¾¾Linkto:CAPstandardsforspecimencollectionandmanagement(649institutions;570,108bloodcultures)ContaminationRate*(percentile)10th50th90thHospitalizedadults5.42.5.9Hospitalizedchildren7.32.3.7Neonates6.52.10.0*percentofculturescontaminatedSource:SchifmanRBetal:Q-ProbesStudy93-08.CollegeAmPath;1993.Interpretinga“Positive”BloodCultureTrueBacteremia:UnlikelyUncertainLikely•S.aureus•S.pneumoniae•Enterobacteriaceae•P.aeruginosa•C.albicans•Corynebacteriumspp.•Non-anthracisBacillusspp.•Propionibacteriumacnes•coagulase-negativestaphylococcipre-testprobabilitypatientriskfactorsprostheticdevicesclinicalevidencepost-testprobability#positive/#culturescompareantibiogramscomparegenotypesPositivePredictiveValue(%)5520985Tokars,JI.ClinInfectDis2004;39:333#ofsetsPositive#ofsetsObtained%Significant%Contam%Indeterm1109731229532260337130100023750253310000¾¾¾IDSAguidelineforevaluatingfeverincriticallyilladults¾Linkto:InvasiveNon-invasiveDiagnosisDiagnosisAntimicrobial-free11.07.5p.001days(atday28)Mortality16.2%25.8%p=.022*413patients;31intensivecareunitsSource:FagonJY,etal:AnnInternMed2000;132:621-30¾¾¾¾¾¾¾¾¾¾6•28•1WBC12G/LPaO248.6mmHg•2••BALF••••••••••//+++--+++ESBL++--++++++++++--+++++ESBLVRE,MRSA,CDAD**ESBL,VRE***ESBL**Rahal,etalJAMA(1998)280:1233-37**Smith,etal.1999(Chest)***KerryM.Empey,etal,Pharmacotherapy22(1):81-87,2002Infection34.2006.No.3127-134•P/TI/CNP•P/TI/CNPInfection34.2006.No.3127-1342003/01~2005/12•SSI7.13%7.3%•SSI•SSI404-76728SSI/VariesbyproductwithinclassinvitroactivityNoinvitroactivityBroadSpectrumTheclinicalsignificanceofinvitroactivityisunknown.Forlistofindicatedorganisms,seePrescribingInformation.cSSSI••++9999TigecyclineRegistrationStudyForalistofindicatedorganisms,seefullPrescribingInformationavailableatthisprogram.••cIAIcIAI//999aDuetosusceptiblestrainsofindicatedorganisms.Foralistofindicatedorganisms,seePrescribingInformationavailableatthisprogram.A.B.C.D.E.••ChillsBloodCulturesBACTEREMIALEVELTemp60300Time(min)BaC&SM.LInfectiousDiseasesExpertResourcesInfectiousDiseasesSpecialistsOptimalPatientCareOptimalPatientCareInfectionControlProfessionalsHealthcareEpidemiologistsClinicalPharmacistsClinicalPharmacologistsSurgicalInfectionExpertsClinicalMicrobiologists••‹‹‹‹‹‹