院内获得性感染的治疗与控制.ppt
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1、医院获得性医院获得性NF-GNBNF-GNB感染的感染的治疗与控制治疗与控制复旦大学附属中山医院复旦大学附属中山医院上海市院内感染质控中心上海市院内感染质控中心 何礼贤何礼贤The Impact of Antimicrobial-Resistant Gram-Negative InfectionsThe Impact of AntimicrobialThe Impact of Antimicrobial-Resistant GramResistant Gram-Negative InfectionsNegative Infections Resistance to antimicrobial
2、agents is increasing among many gram-negative pathogens1 Infection with resistant pathogens is associated with negative health outcomes3,4 Mortality/morbidity Length of ICU and hospital stay Healthcare costs No new antibiotic classes under development2 Highlights the need to optimize existing classe
3、s of antimicrobials1.Gaynes R,et al.Clin Infect Dis.2005;41:848-854.2.Spellberg B,et al.Clin Infect Dis.2004;38:1279-1286.3.Lautenbach E,et al.Infect Control Hosp Epidemiol.2006;27:893-900.4.Cosgrove,S et al.Clin Infect Dis.2006;42:S82-S89.Percentage of Nosocomial Infections Associated With Selected
4、 Pathogens,2003Percentage of Nosocomial Infections Percentage of Nosocomial Infections Associated With Selected Pathogens,2003Associated With Selected Pathogens,20036.526.03.35.0E coli,%9.06.94.410.0Enterobacterspp,%9.516.33.418.1P aeruginosa,%2.13.0Surgical site infection(n=2984)1.69.8Urinary tract
5、 infection(n=4109)2.44.2Bloodstream infection(n=2351)6.97.2Pneumonia(n=4365)Acinetobacter spp,%K pneumoniae,%Type of InfectionData from the National Nosocomial Infections Surveillance(NNIS)System,2003.Percentages of bacterial ICU isolates are shown.Gaynes R,Edwards JR.Clin Infect Dis.2005;41:848-854
6、.Boxes indicate most prevalent gram-negative species isolated for type of infectionG G-杆菌杆菌G G+球菌球菌病原体病原体铜绿假单孢菌铜绿假单孢菌克雷伯菌克雷伯菌大肠埃希菌大肠埃希菌肠杆菌属肠杆菌属不动杆菌不动杆菌嗜麦芽窄食单孢菌嗜麦芽窄食单孢菌流感嗜血杆菌流感嗜血杆菌金黄色葡萄球菌金黄色葡萄球菌肠球菌肠球菌肺炎链球菌肺炎链球菌分离菌株分离菌株12411241608608356356278278275275100100505035835883836161构成比构成比20.620.610.110.12.92.
7、94.64.64.64.61.71.70.80.85.95.91.41.41.01.0胡必杰、何礼贤、张杏怡等胡必杰、何礼贤、张杏怡等.中华医院感染学杂志中华医院感染学杂志.2001;11(13):177-180病原菌种类病原菌种类MRSAMRSA鲍曼不动杆菌鲍曼不动杆菌假单胞菌假单胞菌 铜绿假单胞菌铜绿假单胞菌 其他假单胞菌其他假单胞菌肠杆菌科肠杆菌科洋葱伯克霍尔德洋葱伯克霍尔德其他其他早发且无早发且无MDRMDR病原体病原体(病例数(病例数8 8)株数株数1 12 21 1构成构成2.12.14.34.34.34.3晚发且有晚发且有MDRMDR病原体病原体(病例数(病例数4848)株数株数
8、13139 97 75 55 52 2构成构成27.727.719.119.114.914.911.911.914.414.44.34.3合计合计株数株数1414111112127 75 56 62 22 2构成构成29.829.823.423.425.525.514.914.910.610.612.812.84.34.34.34.3影响因素影响因素覆盖病原菌覆盖病原菌肾功能不全肾功能不全MDRMDR病原体病原体APARCHE APARCHE 分类分类是是否否有有无无有有无无15151515例数例数*3434202046468 88 8464622223232病死率病死率32.432.460.
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