院内获得性感染的治疗与控制

1、The Impact of Antimicrobial-Resistant Gram-Negative InfectionsThe Impact of AntimicrobialThe Impact of Antimicrobial- -Resistant GramResistant Gram- -Negative InfectionsNegative Infections Resistance to antimicrobial agents is increasing among many gram-negative pathogens1 Infection with resistant p

2、athogens 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 classes of antimicrobials1. Gaynes R, et al. Clin Infect Dis. 2005;41:848-854. 2. Spellbe

3、rg 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 Pathogens, 2003Percentage of Nosocomial Infections Percentag

4、e 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 infection(n=4109)2.44.2Bloodstream infection(n=2351)6.

5、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.Boxes indicate most prevalent gram-negative s

6、pecies isolated for type of infection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费晓云、胡必杰、李华茵等费晓云、胡必杰、李华茵等.待发表待发表长征医院、长海医院、市一医院、市六医院、长征医院、长海医院、市一医院、市六医院、瑞金医院、仁济医院、新华医院、肺科医院、瑞金医院、仁济医院、新华医院、肺科医院、华东医院、中山华东医院、中山 医院医院HAP：医院内肺炎：医院内肺炎 HTB：医院内气管支气管炎：医院内气管支气管炎表表1 两组基线资料比较两组基线资料比较两组疗效比较两组疗效比

7、较P均均两组细菌学疗效比较两组细菌学疗效比较P均均心脏外科重症监护室鲍曼不动杆菌暴发感染分子流行病学研究心脏外科重症监护室鲍曼不动杆菌暴发感染分子流行病学研究郭述良郭述良 何礼贤何礼贤 胡必杰胡必杰 张磊张磊 罗永艾罗永艾48.597.0145.5194.0242.5291.0339.5Kb 35株表型相同菌株染色体株表型相同菌株染色体DNA PFGE图谱分析结果图谱分析结果细菌（株）细菌（株）GM-PFGE条带条带图示图示完全相同完全相同13条差异条差异3条差异条差异铜绿假单胞菌（铜绿假单胞菌（n=15）13（5例）例）02（1例）例）图图1肠杆菌科肠杆菌科 图图2 大肠埃希菌（大肠埃希菌（n=2）002（1例）例）图图2 肺炎克雷伯菌（肺炎克雷伯菌（n=2）002（1例）例）图图2 阴沟肠杆菌（阴沟肠杆菌（n=5）5（2例）例）00图图2肺炎链球菌（肺炎链球菌（n=2） 2（1例）例） 图图3鲍曼不动杆菌（鲍曼不动杆菌（n=5）5（2例）例）00图图4金葡菌（金葡菌（n=4）4（2例）例）00图图4表表2两组间细菌胃肺菌株同源率比较两组间细菌胃肺菌株同源率比较组别组别C 组（组（n36）I 组（组（n31）合计合计菌株同