抗生素的历史沿革及演变（英文ppt）uhcw nhs trust clostridium difficile rates 2002 - 2005课件

AntibioticSeniorAcademicHalfDay MattRogers JamesClaytonConsultantMicrobiologistsFebruary2011 Objectivesofthesession Bytheendofthesessionyouwillbeableto DescribethefactorsthatneedtoconsideredwhenmakingthechoicetoprescribeanantibioticDevelopanunderstandingofkeypathogensandtheirsusceptibilitytoantibiotics YouwillbeabletorelatethistotheantibioticpolicywithinyourTrustDefinewhatismeantbythetermAntibioticstewardshipBeawareofkeyDOHguidelines Clostridiumdifficile thatdirectthedevelopmentofantibioticpoliciesNametheantibioticsassociatedwithClostridiumdifficileStatetheminimumrequirementsofhowtoprescribeanantibioticNamethekeyissuesaroundrouteanddurationofantibioticsandhowthisaffectspatients Antibioticstewardship EnsurestheoptimisationofantibioticuseOnlyusewhennecessaryControlwhouseswhatControlrouteanddurationRespondtochangingneedsRespondtochangingEvidence PoliciesRobustpolicing reviewandstopstrategiesEprescribing AbitofbackgroundApottedhistoryofAntibiotics Theuseofantimicrobialsinthetreatmentofinfectionisoneofthetriumphsofmodernmedicine HistoryofAntibiotics Beforethediscoveryofthesulphurdrugsin1932 treatmentofinfectiousdiseasewaslimitedtomercury arsenic andquinine Penicillinwasdiscoveredin1929 AlexanderFleming HistoryofAntibiotics Penicillinwasnotmanufacturedonalargescalefornon militaryuseuntil1949 HistoryofAntibiotics Resistancealwaysdevelops Antimicrobialresistance MultipleresistancegenesPlasmidsSpreadFactorsleadingto resistance InappropriateclinicaluseofABxPoorinfectioncontrolExcessiveABxuseinnonclinicalsettings animalhusbandryshipping Keyantibioticchanges StopuseofcefuroximethroughouttheTrustUselowerriskaugmentin butmonitorC difficilerates Reduceuseofciprofloxacin considerpenicillinallergy AntibioticpolicyavailableunderClinicalGuidelinesontheintranetAntibioticguidelinecreditcardsdistributed Antibioticstewardship EnsurestheoptimisationofantibioticuseOnlyusewhennecessaryControlwhouseswhatControlrouteanddurationRespondtochangingneedsRespondtochangingEvidence PoliciesRobustpolicing reviewandstopstrategiesEprescribing AntibioticprescribingWhat simportant WhenIsthereaninfection HowTodiagnose Whatspecimens WhyWhatistheindication Likelypathogens WhatWhatantibiotic route duration When DiagnosinginfectionisaCLINICALskillBasicsignsandsymptomsofinfectionPleaserememberapartfromsterilesites urine csf bloodetc mostareasyoucultureWILLgrowbacteria Whennotto CSU urinecloudy ChestinfectionwithnoevidenceonCXRWoundwithserousexudateSloughyUlcersIsolatedspikesoftempTotreatahighWCC How HowtodiagnoseInfection Whatspecimensdoyouneedtotake Whatinvestigationsdoyouneedtoaskfor Why WhyarewegivingAntibioticsEmpirical Prophylactic TargetedKnowyourbasicMicrobiologyTheindication UTI LRTIetc Thesetting Pt environment HospitalvCommunity feasibility Thelikelypathogens CRRS Prophylaxis TherapygiventopreventaninfectionOftengivenaroundsurgeryGiventopatientspronetoparticularinfectionsContactsofNeisseriameningitidismeningitisGiventopatientswhoarespecificallyimmunocompromisedSplenectomyPCPprophylaxisinHIV Surgicalprophylaxis UsedtobegivenforseveraldaysEvidencenowsuggeststhatperi operativeantibioticsadequateformost clean operations Principlesofantibioticprophylaxis Theuseofantibioticprophylaxisinvolvesadilemma itishighlyeffectiveinpreventinginfection butcanpromoteresistance Limittothoseindividualsinwhomtheriskofinfectionishigh Principlesofantibioticprophylaxis Whichantibiotics shouldbetargetedtothemostlikelypathogens When administrationasnearthetimeofincisionaspossible Intravenousantibioticsshouldbegivenduringtheinductionofanaesthesiawithrepeatdosesforlongerprocedures Duration keeptoaminimum ofteneventoasingle dose toreducethechanceofresistancedeveloping Thebenefitsofpost operativeprophylaxislastingmorethan12hhavenotbeenproven Indicationsforantibioticprophylaxis Contaminatedordirtyoperationspresenceofbowelcontents pus orinfectedforeignmaterialInsertionofgraftorprosthesiswheredevelopmentofinfectionwouldbeserious ImmunocompromisedpatientsPatientswithcardiovascularabnormalities mayrequirespecificantibioticprophylaxistoreducetheriskofendocarditis NICEguidelines BSACguidelines RiskFactorsforSurgicalSiteInfection Patient ExtremesofagePoornutritionalstateObesityDiabetesmellitusSmokingCo existinginfectionsatothersitesBacterialcolonisation e g MRSA ImmunosuppressionProlongedpostoperativestay OperationLengthofsurgicalscrubSkinantisepsisPreoperativeshavingPreoperativeskinprepLengthofoperationAntimicrobialprophylaxisOperatingtheatreventilationInadequateinstrumentsterilisationForeignmaterialinsurgicalsiteSurgicaldrainsSurgicaltechniqueincludinghaemostasis poorclosure tissuetraumaPostoperativehypothermia SIGN ScottishIntercollegiateGuidelinesNetwork www sign ac ukwww sign ac uk guidelines fulltext 104 index htmlSIGNqrg104 pdf Empiricaltherapy TherapygivenwithoutknowingthecausativeorganismChoicebasedonpracticalexperienceandevidencebasedmedicine Bestguesstherapy unlikelytocoverallpossibilities Targetedtherapy TherapygivenwhentheinfectionandcausativeorganismisknownThisisthebestwayofeffectivetreatmentWeshouldknowtheactualsensitivityoftheoffendingpathogen What Considerationsintherapy Choiceofagentincludes RecentDOHguidance Clostridiumdifficile HasalteredpoliciesRangeofpathogens Why Infectionsite drugpenetrationPatientfactors allergy TheaboveshouldbecoveredbyyourantibioticpolicyCombinationtherapy synergy antagonism Dose FrequencyRoute IV oralIV oralswitchDuration 5 7daysformostinfection Patientfactors AllergyOthermedications interactions CantheytakePOToleranceCompliance Infectionsite Drugpenetratione g Antibioticsaren talwaystheanswerInfectionprostheses SURGERYBone SofttissueinfectionsSomedrugsliketheaminoglycosidesdonotpenetratewellMeningitisManydrugswillnotpenetrateCSFwell IVororal WhataretheconsiderationsDependsonsiteofinfectionOralbioavailabilityoftheantibioticClearaim endpoint treatment suppression Licencing MAUAuditZoeCampbellF2SHO OnlythosewithSeverepneumoniaaccordingtoCURBcriteriashouldreceiveIVantibiotics18outof25patientsreceivedIVantibiotics18patientswereclassifiedmild mod Oralantibiotics 7patientswereclassifiedsevere IVantibiotics MAUAudit IV OralSwitch Only2outof25 8 patientshadanIVtooralswitchorareview stopd