课件：重症感染的抗感染治疗及其策略.ppt

Data on 10 patients in the international study were combined with 26 previously reported patients. A total of 83% (30 of 36) were bacteremic. Of these 36 patients, 4 were excluded from further analysis (2 were treated with a cephamycin and 2 died within 48 hours of beginning treatment). 4 patients had organisms with an intermediate susceptibility to cephalosporins. Of the remaining 32 patients, 54% (15/28) had clinical failure. Four patients with clinical failure with cephalosporins to which organisms were “susceptible” died. Eleven patients were cured with a change in antibiotic therapy (change to carbapenem in all cases but one). The graph above illustrates results from three separate studies showing that treatment, in this case treatment with activated C protein, hydrocortisone, or adequate antibiotic therapy, impacts mortality. A prospective, randomized, double-blind, multicenter, placebo controlled 28-day study was conducted from July 1998 through June 2000 to evaluate the effects of drotrecogin alfa activated (activated protein C) in patients (n=1728) with severe sepsis and a known or suspected infection.7 Patients had to have the following within a 24-hour period: three or more signs of systemic inflammation and the sepsis-induced dysfunction of at least one organ or system, lasting no longer than 24 hours. Drotrecogin alfa activated was administered by infusion at 24 mg/kg body weight per hour, for a total of 96 hours. At 28 days after infusion, 31% (259/840) of the placebo group and 25% (210/850) of the treatment group had died (p=0.005), representing a 19.4% reduction in the relative risk of death and a 6.1% absolute reduction in the risk of death. A randomized, double-blind, parallel group, multicenter, 7-day, placebo controlled study was conducted in France between 9 February 1995 and 15 March 1999 to evaluate whether hydrocortisone (50 mg bolus every 6 hours) and fludrocortisone (one 50 mg tablet daily, administered nasogastrically over 30 seconds)