抗生素优化管理_1

1、会计学1抗生素优化管理抗生素优化管理_14Adapted from Chow JW, et al. Surg Infect (Larchmt). 2006;6(4):439448.Slide 7EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = tazobactam/piperacillin; AMK = amikacin; LVX = levofloxacin; CIP

2、= ciprofloxacin.Slide 8EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = tazobactam/piperacillin; AMK = amikacin; LVX = levofloxacin; CIP = ciprofloxacin.Slide 9EPM = ertapenem; IMP = imipenem; FEP = cefepime; FO

3、X = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = tazobactam/piperacillin; AMK = amikacin; LVX = levofloxacin; CIP = ciprofloxacin.Slide 10EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampi

4、cillin; TZP = tazobactam/piperacillin; AMK = amikacin; LVX = levofloxacin; CIP = ciprofloxacin.Slide 11EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = tazobactam/piperacillin; AMK = amikacin; LVX = levofloxacin

5、; CIP = ciprofloxacin.Slide 12EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = tazobactam/piperacillin; AMK = amikacin; LVX = levofloxacin; CIP = ciprofloxacin.Slide 13aCefepime and cefepime/clavulanic acid used

6、 to determine ESBL status; ceftazidime and cefotaxime with/without clavulanic acid were used 20052007.Adapted from Badal R, et al. Poster presented at: 48th Annual ICAAC; 2528 October 2008.Prevalence of ESBL-Producing Strains Among 18,845 E. coli, K. pneumoniae, and K. oxytoca Isolates2004aPrevalenc

7、e, %Asia/PacificLatin AmericaMiddle East/AfricaEuropeNorth America045402003a2005200620073530252015105Slide 14Slide 15Slide 15Community Onset (=48 hours)Slide 16EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = ta

8、zobactam/piperacillin; AMK = amikacin; LVX = levofloxacin; CIP = ciprofloxacin.Slide 17Slide 18Slide 18Community Onset (48 hours)Slide 19EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = tazobactam/piperacillin;

9、AMK = amikacin; LVX = levofloxacin; CIP = ciprofloxacin.2,292 Isolates, SMART, IAI, China, 2002-2007(N=125)(N=144)(N=147)(N=145)(N=287)(N=287) SMART, IAI, China, 2002-2007 , China, 2002-2007 , China, 2002-200760 岁岁2.65糖尿病糖尿病2.57Colodner et al EJCMID 2004 23, 163.无多重耐药风险无多重耐药风险肠杆菌多重耐药风险肠杆菌多重耐药风险假单胞菌多

10、重耐药风险假单胞菌多重耐药风险 是否接触医疗系统没有医疗机构接触史有医疗机构接触史（如近期住院史，家庭护理史，透析），没有有创操作史长期住院病史，或有创操作史（5天） 先前有无抗生素使用没有近期抗生素使用史近期抗生素使用史（在过去90天内至少14天使用过抗生素）近期抗生素使用史（在过去90天内至少14天使用过抗生素） 病人特点年轻，无或较少合并症至少65岁，有合并症如全胃肠外营养或肾功能不全等病人特点：囊性纤维化，结构性肺病，晚期AIDS，中性粒细胞减少症，或其他严重免疫缺陷TPN=total parenteral nutrition. 肠外营养aExcept nonfermenters/no

11、n-Pseudomonas species.除了非酵菌/非单胞菌Adapted from Carmeli Y. Predictive factors for multidrug-resistant organisms. In: Role of Ertapenem in the Era of Antimicrobial Resistance newsletter. Available at: http:/www.invanz.co.il/secure/downloads/IVZ_Carmeli_NL_2006_W-226364-NL.pdf. Accessed 7 April 2008; Dim

12、opoulos G, Falagas ME. Eur Infect Dis. 2007;4951; Ben-Ami R, et al. Clin Infect Dis. 2006;42(7):925934; Pop-Vicas AE, DAgata EMC. Clin Infect Dis. 2005;40(12):17921798; Shah PM. Clin Microbiol Infect. 2008;14(suppl 1):175180.60产ESBL是否与更高的死亡率相关?l Meta分析：产ESBL菌株所致菌血症的死亡率 Schwaber JAC Nov 2007u2000-200

13、6 共有16个研究u粗死亡率：产ESBL组34（199/591）vs 非产ESBL组 20 （216/1091）uPooled RR 1.85; 95% Cls 1.39-2.47l 对产ESBL的有效治疗的延迟达44 Schwaber JAC Nov 2007; Goff ICAAC 20062022-5-462 Overall (N=85) ESBL - (N=54) ESBL+ (N=31) P-value 性别：男性性别：男性51 (60.0) 35 (64.8) 16 (51.6) 0.257 病原菌：病原菌：E.Coli66 (77.6) 42 (77.8) 24 (77.4) 1

14、.000 Klebsiella19 (22.4) 12 (22.2) 7 (22.6) p = 0.01681.5%58.1%ESBLs(-)ESBLs(+)反应率（%）100806040200中国参与中国参与SMART(抗生素耐药性趋势监测研究抗生素耐药性趋势监测研究)的的6家机构进行的研究结果家机构进行的研究结果n=54n=31p 0.001n=54n=31ESBLs(-)ESBLs(+)总住院天数（天）252015105014.5天天24.5天天中国参与中国参与SMART(抗生素耐药性趋势监测研究抗生素耐药性趋势监测研究)的的6家机构进行的研究结果家机构进行的研究结果p = 0.052n

15、=54n=31ESBLs(-)ESBLs(+)2500020000150001000050000总住院费用（元）15217.521498.4中国参与中国参与SMART(抗生素耐药性趋势监测研究抗生素耐药性趋势监测研究)的的6家机构进行的研究结果家机构进行的研究结果p =0.014n=54n=31ESBLs(-) ESBLs(+)抗菌药物 543210p =0.016n=54n=31ESBLs(-) ESBLs(+)抗菌药物数量抗菌药物种类2.5中国参与中国参与SMART(抗生素耐药性趋势监测研究抗生素耐药性趋势监测研究)的的6家机构进行的研究结果家机构进行的研究结果68Slide 69EPM = ertapenem; IMP = imipenem; FEP = cefepime; FOX = cefoxitin; CAZ = ceftazidime; CRO = ceftriaxone; SAM = sulbactam/ampicillin; TZP = tazobactam/piperacillin; AMK = amikacin; LVX = levofloxacin; CIP = ciprofloxacin.S