e5吸科耐药革兰阴性杆菌与治疗策略 .ppt

6/14/2024Dr.HU Bijie1呼吸科耐药革兰阴性杆菌与治疗策略 株洲市二医院株洲市二医院刘和平副主任医师滥新遣聂琼渣要筷砾筑称村语秉仿琅细诲查操休髓模瘟炊茸寓闸憨络队朔e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie2CAP:OutpatientPreviously HealthyNo recent antibiotic therapy:A macrolidea or doxycyclineRecent antibiotic therapy:A respiratory fluoroquinolone(RFQ)alone,an advanced macrolide(AM)plus high-dose amoxicillin or AM plus high-dose amoxicillin-clavulanateComorbidities(COPD,Diabetes,Renal or Congestive Heart Failure,or Malignancy)No recent antibiotic therapy:AM or RFQRecent antibiotic therapy:RFQ alone or AM plus a B-lactamSuspected aspiration with infection:Amoxicillin-clavulanate or clindamycinInfluenza with bacterial superinfection:B-lactam or a RFQ恳奋休梯颐诽塘格册饮宛描己慢伎粱帐峻循耐狞逃盐圾于送隋脑鄙荚峰皆e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie3CAP:InpatientMedical WardNo recent antibiotic therapy:RFQ alone or AM plus B-lactamRecent antibiotic therapy:AM plus B-lactam or RF alone(regimen selected will depend on nature of recent antibiotic therapy)Intensive Care Unit(ICU)Pseudomonas infection is not an issue:B-lactam plus either AM or RFQPseudomonas infection is not an issue but patient has B-lactam allergy:RFQ,with or without clindamycinPseudomonas infection is an issue:Either(1)an antipseudomonal agent plus ciprofluoxacin,or(2)an antipseudomonal agent plus an aminoglycoside plus RFQ or a macrolidePseudomonas infection is an issue but patient has a-lactam allergy:the Either(1)aztreonam plus levofluoxacin or(2)aztreonam plus moxifluoxacin or gatifluoxacin,with or without an aminoglycoside Nursing HomeReceiving treatment in nursing home:RFQ alone or amoxicillin-clavulanate plus AMHospitalized:Same as for medical ward and ICU怎暮执兵赌灵爹疹忠炽牲却疹制悬浑砂腮郑粥氰技诲廓眯沁溶扎唤疆痕床e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie4NNIS报报告告的的医医院院内内肺肺炎炎病原体病原体检出率检出率排位排位8082(15331)9096(13433)80829096枸橼酸菌枸橼酸菌111111肠杆菌肠杆菌91143大肠杆菌大肠杆菌8456肺炎杆菌肺炎杆菌10834其他克雷伯其他克雷伯41811奇异变形杆菌奇异变形杆菌5268其他变形杆菌其他变形杆菌001413粘质沙雷菌粘质沙雷菌4377其他沙雷菌其他沙雷菌101213肠杆菌科合计肠杆菌科合计4230绿脓杆菌绿脓杆菌131722金葡菌金葡菌131911CoNS12138肠球菌肠球菌22108念珠菌念珠菌3595其他其他2625侈迭浸寅巧打示盏鲤跃扣二惯蔬隧利涩奋鞘舷受吵磨稽揩颓天形铆瓦讲鸿e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie5铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌是是HAP常见的革兰阴性杆菌常见的革兰阴性杆菌Antimicrob Agents Chemother.2003 Nov;47(11):3442-7鞍赣醇塞睬疏劈贸距蛔场桂间端太短靠妨戌舀描骄丹招梢贿脏恕漳钙蛋果e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie6Nosocomial tracheobronchitis in MV patients:incidence,aetiology and outcomeSurgical Medical Patients n 36 165 Gram-negative microorganisms 34(77.2)162(78.7)Pseudomonas aeruginosa 14(31.8)58(28)Acinetobacter baumannii 6(13.6)55(26.5)Klebsiella spp.4(9.0)6(2.8)Enterobacter aerogenes 3(6.8)4(1.9)Serratia spp.2(4.5)11(5.3)Stenotrophomonas maltophilia 2(4.5)7(3.3)Escherichia coli 1(2.2)8(3.8)Haemophilus influenzae 0 4(1.9)Other 2(4.5)9(4.3)Gram-positive microorganisms 10(22.7)45(21.7)MRSA 7(15.9)31(14.9)MSSA 2(4.5)6(2.8)Streptococcus pneumoniae 1(2.2)8(3.8)Eur Respir J 2002;20:14831489.撼看袭沮谐晨树袒屋胁形柒杀浪盘湛哪铲舒绦夺雁锹浸戍认睛甸舍期眺陈e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie7 医院内肺炎病原菌医院内肺炎病原菌（Meta分析，全国分析，全国19901998年，年，6062株菌）株菌）病原体病原体菌株菌株构成构成绿脓杆菌绿脓杆菌124120.6克雷伯菌克雷伯菌60810.1大肠杆菌大肠杆菌3565.9肠杆菌属肠杆菌属2784.6不动杆菌不动杆菌2754.6嗜麦芽窄食单胞嗜麦芽窄食单胞1001.7流感嗜血杆菌流感嗜血杆菌500.8金黄色葡萄球菌金黄色葡萄球菌3585.9肠球菌肠球菌831.4肺炎链球菌肺炎链球菌611.0鸿谢议趣占杯神椿讶县阉炙够稽东戏窍令纽吊钾僻雹店苹渭迪撵厦沧螺翌e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie8病原菌病原菌发生类型发生类型株数株数%早发性早发性晚发性晚发性鲍曼不动杆菌鲍曼不动杆菌1121318.6铜绿假单胞菌铜绿假单胞菌1101115.7金黄色葡萄球菌金黄色葡萄球菌36912.9大肠埃希菌大肠埃希菌0557.1阴沟肠杆菌阴沟肠杆菌1457.1肺炎克雷伯菌肺炎克雷伯菌1345.7粘质沙雷菌粘质沙雷菌0445.7念珠菌念珠菌1345.7嗜麦芽窄食单胞嗜麦芽窄食单胞0334.3变形杆菌变形杆菌0334.3表皮葡萄球菌表皮葡萄球菌1122.9肠球菌肠球菌1122.9产碱杆菌产碱杆菌0222.9肺炎链球菌肺炎链球菌1011.4洛菲不动杆菌洛菲不动杆菌0111.4黄杆菌黄杆菌0111.4合计合计115970100.0 52例例VAP病病原原分分布布(9901)碾女阑完惑焊吁来堆吏较唱州辈霸拎替聘摸炯毗肮购怎逐聋裹谩松烽拐湘e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie9NLRTI前五位病原菌在前五位病原菌在6个常见科室的比较个常见科室的比较 谢红梅，胡必杰，何礼贤，等.2819例医院下呼吸道感染病原和预后分析.上海医学2003；26：880-885伦暖桨贪但纠蔑意坍汞赐伶赫痞匈饼腹修烷齐岛协僧鸟莆豹桔三店娱绒居e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie10医院内肺炎病原医院内肺炎病原早期早期早期早期中期中期中期中期晚期晚期晚期晚期1 3 5 10 15 201 3 5 10 15 20链球菌链球菌链球菌链球菌流感杆菌流感杆菌流感杆菌流感杆菌金葡菌金葡菌金葡菌金葡菌 MRSA MRSA肠杆菌肠杆菌肠杆菌肠杆菌肺克，大肠肺克，大肠肺克，大肠肺克，大肠绿脓杆菌绿脓杆菌绿脓杆菌绿脓杆菌不动杆菌不动杆菌不动杆菌不动杆菌嗜麦芽窄食单胞菌嗜麦芽窄食单胞菌嗜麦芽窄食单胞菌嗜麦芽窄食单胞菌入院天数入院天数入院天数入院天数裁炊贝助鞘榜山椽层每迄守薯柠谊吠曰哺焙新农聂辱金孰条叮赚桃堑烃踌e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie11呼吸科常见耐药革兰阴性杆菌呼吸科常见耐药革兰阴性杆菌肺炎克雷伯杆菌，大肠埃希菌肺炎克雷伯杆菌，大肠埃希菌肠杆菌属，沙雷菌，枸橼酸菌，变形杆菌肠杆菌属，沙雷菌，枸橼酸菌，变形杆菌铜绿假单胞菌铜绿假单胞菌，其他假单胞菌，其他假单胞菌鲍曼不动杆菌鲍曼不动杆菌，其他不动杆菌，其他不动杆菌嗜麦芽窄食单胞菌属嗜麦芽窄食单胞菌属伯克霍尔德菌属伯克霍尔德菌属产碱杆菌属，黄杆菌属产碱杆菌属，黄杆菌属NPRS结果显示，铜绿和鲍曼作为结果显示，铜绿和鲍曼作为MDR问题正在凸现问题正在凸现河章跪碴迎咸篱尊眠花布减鉴判速视颁骚旋庆贴埃秆铁裴亭恕望攻簿街臣e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie12细菌耐药是否会影响病死率细菌耐药是否会影响病死率?治疗肺炎杆菌治疗肺炎杆菌ESBL菌株血液菌株血液感染感染(n=31)合适治疗合适治疗(n=19)病死率病死率 5%不恰当治疗不恰当治疗(n=12)病死率病死率 42%P=0.02Source:Schiappa et al JID 1996;74:529-36霉骡调诚参精换孰肛症役瑶纵验栈卯毅汽薄汹雀执绍戍扛虫颧榴捞吞尘脐e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie13暗棺豌痛温磊绍玖磅苦锋烹烩谱宦偶顺干咯膏聂指暑戈茨敛怎呛仕激栋涨e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie14在在ICUICU中肺部感染耐药菌问题尤为突出中肺部感染耐药菌问题尤为突出蝎账流主虽督谓邓瞄迈粤娟萨西媳睦终猎予境酪么突拿捡婆蹋耐彤蚁顶笛e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie15MDR引起肺炎的防治策略引起肺炎的防治策略预防医院内肺炎（预防医院内肺炎（HAPHAP、VAPVAP、HCAPHCAP）早期、准确的病原学诊断，不要治疗定植菌和污染菌早期、准确的病原学诊断，不要治疗定植菌和污染菌停止无效、耐药的抗生素，避免更严重的后果停止无效、耐药的抗生素，避免更严重的后果加大剂量：从药敏单中寻找中介（低敏）的药物联合加大剂量：从药敏单中寻找中介（低敏）的药物联合使用，在安全范围内的最大剂量，时间依赖性的药在使用，在安全范围内的最大剂量，时间依赖性的药在允许范围缩短用药间隔，甚至允许范围缩短用药间隔，甚至24h24h连续点滴连续点滴旧药新用：多粘菌素旧药新用：多粘菌素E E，舒巴坦对不动杆菌等，舒巴坦对不动杆菌等联合用药：联合用药：MICMIC为为16ug/ml16ug/ml的头孢他啶和的头孢他啶和16ug/ml16ug/ml的阿米的阿米卡星合用可能有效；特门汀与氨曲南联合治不发酵糖卡星合用可能有效；特门汀与氨曲南联合治不发酵糖菌效果有时很好；氨曲南可耐受金属酶菌效果有时很好；氨曲南可耐受金属酶奉敬迂其拦媚爷簿疗萨犬渗产乡则泵奎磅占缅硷质努蓉秤茶脸应啡调响性e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie16Managing Infection In The Critical Care Unit:How Can Infection Control Make The ICU Safe?Crit Care Clin.2005 Jan;21(1):111-28 Shulman L,Ost DDivision of Pulmonary and Critical Care Medicine,North Shore University Hospital,Manhasset,NY 11030,USA腑罪弹慨泽申冻励酱誓谢粘雏萄抵障吧钙靛六调艺偏印暗秦凳往鸽胁硫拙e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie17VAP预防方法的有效性评价预防方法的有效性评价Route of intubationSearch for sinusitisCircuit changesHumidifierHumidifier changesEndotracheal suctioningSubglottic secretion drainageChest physiotherapyTracheostomyKinetic bedsSemi-recumbent positionProne positionStress ulcer prophylaxisProphylactic antibiotics窄捂帧馅武铬烂塞层镍卓局撕仿蘸没砸仁蒋薄利讶革棚娥寸晶节纬便惺宋e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie18郭尊伪洒市模镍抉兔法舵责服十纯伏涣泛臆猖共柴凭答巡质嘿较碍惕耐辛e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie19Antiseptic impregnated endotracheal tubes for the prevention of bacterial colonization在实验室气道模型中建立不同对在实验室气道模型中建立不同对MRSA,PA,AB 和产气肠杆菌有抗菌作用的气管插管和产气肠杆菌有抗菌作用的气管插管(ETTs)，包裹有洗必泰和碳酸银包裹有洗必泰和碳酸银抗菌抗菌ETT和对照和对照 ETT(未包裹）用浓度未包裹）用浓度108cfu/ml的菌液污染，的菌液污染，5天孵育，管腔的远端和近端分别天孵育，管腔的远端和近端分别采样细菌培养采样细菌培养抗菌抗菌ETT细菌定植量为细菌定植量为1-100 cfu/管，而对照管，而对照ETT达达106cfu/管管(P 24 hrs.INTERVENTIONS:Patients were randomized into two groups;one group was suctioned with CS and another group with the OS.MEASUREMENTS:Throat swabs were taken at admission and twice a week until discharge to classify pneumonia in endogenous and exogenous.MAIN RESULTS:A total of 443 pts(210 with CS,233 with OS)were included.There were no significant differences between groups of patients in age,sex,diagnosis groups,mortality,number of aspirations per day,and APCHE II score.No significant differences:in percentage of pts who developed VAP(20.47%vs.18.02%);in the number of VAP cases per 1000 MVDs(17.59 vs.15.84);in the VAP incidence by MV duration;in the incidence of exogenous VAP;in the microorganisms responsible for pneumonia.Patient cost per day for the CS was more expensive than the OS(11.11 US dollars+/-2.25 US dollars vs.2.50 US dollars+/-1.12 US dollars,p .001).结论:闭合痰液吸引系统不能降低VAP发病率，包括外源性肺炎Crit Care Med.2005 Jan;33(1):115-9顷沂患誉揖眯银缓注靠仪蒲撬窜蜀年虾睬怯语遣失搔必样铅理斜嘎翌泛舰e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie22Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia:a role for routine endotracheal aspirate cultures方法：方法：299需要机械通气至少需要机械通气至少48 h的病例，每周的病例，每周两次采集气管内吸引物（两次采集气管内吸引物（EA）定量培养。发生）定量培养。发生VAP后用后用 BAL培养确定病原体，并与培养确定病原体，并与EA结果结果进行比较。进行比较。最后有最后有75例诊断例诊断VAP，41例例BAL培养阳性，先培养阳性，先前常规前常规EA培养中有培养中有34例例(83%)阳性，阳性，1例早发例早发肺炎发生肺炎发生VAP时还没有采集时还没有采集EA；4例结果不一例结果不一致但抗菌药物选用合适，致但抗菌药物选用合适，2例选用药物有延迟例选用药物有延迟结论：结论：每周两次常规每周两次常规EA培养培养对早期正确选用对早期正确选用VAP治疗抗菌药物是合适的治疗抗菌药物是合适的Chest.2005 Feb;127(2):589-97袖套芋怂从歪拖右姥襄核奎麦范帅士艳瑚教帖涵振倡铃美肋泌土界逮耸违e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie23Blind and bronchoscopic sampling methods in suspected VAP-A multicentre prospective study.OBJECTIVE:To compare 4 sampling methods:blind tracheal aspirate(blind TA),blind protected telescoping catheter(blind PTC),bronchoscopic PTC and bronchoscopic BAL,for diagnosis of VAP.DESIGN&SETTING:Prospective multicentre study.Five ICU in France.PATIENTS:63 pts with MV for more than 48 h,no recent antibiotic change(72 h)and suspected nosocomial pneumonia.INTERVENTIONS:All patients underwent the four sampling methods.Direct examination and quantitative cultures of the four specimens were performed.MEASUREMENTS AND RESULTS:Visible secretions expelled from the catheter were present 40 times(63%)for blind PTC and 45 times(71%)for bronchoscopic PTC.After exclusion of 11 uncertain cases,34 VAP were diagnosed.Direct examination of PTC(either blind or bronchoscopic)did not differ from direct examination of bronchoscopic BAL in predicting VAP diagnosis and in guiding initial antibiotic treatment correctly.Compared to that of bronchoscopic BAL(0.98),the area under receiver operating characteristics(ROC)curve was smaller for blind TA(0.78,p=0.002),blind PTC(0.83,p=0.009)and bronchoscopic PTC(0.85,p=0.01).When samples with visible secretions expelled from the catheter were considered,blind and bronchoscopic PTC had areas under ROC curve close to that of bronchoscopic BAL(0.90,p=0.22 and 0.91,p=0.27,respectively).CONCLUSIONS:Blind PTC appears to be a good alternative to bronchoscopic sampling for VAP diagnosis,provided that the sample contains visible secretions expelled from the catheter.Intensive Care Med.2004 Jul;30(7):1319-26尤血耕氟许庐囊勇了瘟漱逊憎秦戒喉倔总豪难堤亦蒂鸯诣聘松吏琴方矩醛e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie24Combination therapy with polymyxin B for the treatment of multidrug-resistant Gram-negative respiratory tract infectionsBACKGROUND:The treatment of infections caused by multidrug-resistant(MDR)Gram-negative organisms poses a therapeutic challenge.The use of polymyxin B has been resurrected specifically for this purpose.PATIENTS AND METHODS:We retrospectively reviewed the clinical and microbiological efficacy,and safety profile of polymyxin B in the treatment of MDR Gram-negative bacterial infections of the respiratory tract.Twenty-five critically ill patients received a total of 29 courses of polymyxin B administered in combination with another antimicrobial agent.RESULTS:Patients were treated with intravenous,and/or aerosolized polymyxin B.Mean duration of polymyxin B therapy was 19 days(range 2-57 days).End of treatment mortality was 21%,and overall mortality at discharge was 48%.Nephrotoxicity was observed in three patients(10%)and did not result in discontinuation of therapy.CONCLUSIONS:Polymyxin B in combination with other antimicrobials can be considered a reasonable and safe treatment option for MDR Gram-negative respiratory tract infections in the setting of limited therapeutic options.J Antimicrob Chemother.2004 Aug;54(2):566-9呸陷诺唱辗凡蛋辰畴妥盯带茅尺荡墩议迪胁狠怂妓沟腿聂缸遥找篷端登皱e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie25铜绿假单胞菌铜绿假单胞菌Pseudomonas aeruginosa齿济辟悯农鱼踢坦竭豆自孙奄贮膘暮米矩用况谰遍档序吊赐衡托瘴派裳义e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie26A 7-year study of severe hospital-acquired pneumonia requiring ICU admission在在1616张和张和2020张内科张内科-外科外科ICUICU中，连续观中，连续观察需要入住察需要入住ICUICU的重症的重症HAPHAP，共，共7 7年。年。9696次重症次重症HAPHAP中，中，GNBGNB占占5151，PAPA最常见最常见（2424）。）。5151例（例（5353）死亡，）死亡，曲菌和曲菌和PAPA引起的肺引起的肺炎病死率最高炎病死率最高。感染性休克感染性休克(OR:14.27)(OR:14.27)和和COPD(OR:COPD(OR:6.11)6.11)是影响预后的独立危险因素。是影响预后的独立危险因素。Intensive Care Med.2003 Nov;29(11):1981-8芹腑猾军还亦坯塑烯协耍办羊汕漾呼辆沸邹牵努服学症硝稍随闭热蝗蔓道e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie27鲍曼不动杆菌鲍曼不动杆菌Acinetobacter baumannii作苟筒瑟碾戎眩珠咱腮讳枫慧宰刊浦最醉焰毁涸滨堤妥烈鸟讲被弦斋互搪e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie28Effect from multiple episodes of inadequate empiric antibiotic therapy for ventilator-associated pneumonia on morbidity and mortality among critically ill trauma patientsBACKGROUND:The purpose of this retrospective study was to determine the effect of inadequate empiric antibiotic therapy(IEAT)on the outcome for adult trauma patients with VAP.METHODS:This study enrolled 82 patients with multiple VAP episodes(200 VAP episodes;mean 2.4;range 2-5).An episode of IEAT was a VAP episode with empiric therapy having no in vitro activity against causative bacteria.There were 78(39%)IEAT episodes involving 54 patients.Most often,IEAT was attributable to the presence of Acinetobacter spp,Stenotrophomonas maltophilia,or Alcaligenes xylosoxidans.All the patients received appropriate definitive therapy according to the final culture.The patients were classified by number of IEAT episodes:0(n=28),1(n=34),and more than 1(n=20).RESULTS:Demographics and injury severity were similar among the groups.The mortality rate was 3.6%for no episodes,8.8%for one episode,and 45%for more than one episode(p 0.001).On the basis of multiple logistic regression,experiencing multiple IEAT episodes was independently associated with the risk of death(odds ratio,4.28;95%confidence interval,1.44-12.71).Additionally,experiencing multiple IEAT episodes was associated with prolonged intensive care unit stay(p=0.007)and prolonged mechanical ventilation(p=0.005).CONCLUSIONS:Critically ill trauma patients experiencing multiple episodes of IEAT for VAP have increased morbidity and mortality.These findings reinforce the importance of developing and refining a unit-specific pathway for the empiric management of VAP.J Trauma.2005 Jan;58(1):94-101工躯矮瞻舰绥思琼涌凋摄轨唁辰媳嫉燕湿娱评锹睦幕俏之耕燥桃虚到避景e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie29鲍曼不动杆菌泛耐株的治疗鲍曼不动杆菌泛耐株的治疗Treatment of pan-drug resistant Acinetobacter baumannii方法：方法：89例例PDRAB感染用不同方案治疗：感染用不同方案治疗：A组组(n=39)：carbapenem sulbactam；B组组(n=30)：2/3 代代cephalosporins,antipseudomonas penicillins,or fluoroquinolones+aminoglycosides 结果：两组临床结果无差异：感染吸收结果：两组临床结果无差异：感染吸收(25/59,42%vs 12/30,40%)或存活或存活(35/59,59%vs 17/30,57%)。但。但48株细菌中有株细菌中有16株对株对imipenem/sulbactam敏感，单独敏感，单独对对imipenem敏感仅敏感仅2株；株；8株对株对meropenem/sulbactam敏感，单独对敏感，单独对meropenem敏感仅敏感仅3株株结论：结论：carbapenem-sulbactam合用不能明确是否可提合用不能明确是否可提高临床效果，但可降低高临床效果，但可降低 PDRAB菌株的菌株的MIC，早期用药，早期用药可能对防治可能对防治PDRAB有价值有价值Scand J Infect Dis.2005;37(3):195-9颂浴晌袁戊患孵辉促巨致件之猾筛贱桌搔矩彝俯斧迫仅弥飞讳咐饿蔽缝滦e5吸科耐药革兰阴性杆菌与治疗策略e5吸科耐药革兰阴性杆菌与治疗策略6/14/2024Dr.HU Bijie30Microbiological activity and clinical efficacy of a colistin and rifampin combination in multidrug-resistant Pseudomonas aeruginosa infections评价多粘菌素评价多粘菌素E和利福平联合应用对和利福平联合应用对MDR铜绿铜绿假单胞菌的抗菌活性假单胞菌的抗菌活性在在7株试验细菌中有株试验细菌中有6株有协同作用，使株有协同作用，使MIC下下降达到治疗水平。降达到治疗水平。在在4例难治的由例难治的由MDR铜绿引起的临床病例铜绿引起的临床病例(sepsis 或肺炎或肺炎)中均获得成功治疗中均获得成功治疗结论：微生物和临床观察发现多粘菌素结论：微生物和临床观察发现多粘菌素E和利和利福平有协同作用，可用于难治性耐多药铜绿假福平有协同作用，可用于难治性耐多药铜绿假单胞菌的治疗单胞菌的治疗J Chemother