院内获得性肺炎的抗生素治疗进展.ppt

**Slide*IfESBL-producingbacteriaareallowedtoflourishandcauseclinicalinfection,theuseofevenmorebroad-spectrumantibioticswillbenecessary,includingtheuseofcarbapenemagents.AlthoughthisclearlycanleadtocureofagiveninfectioncausedbyanESBL-producingbacteria,severalpublishedreportslinkincreaseduseofcarbapenemantibioticstooutbreaksofmultidrug-resistantP.aeruginosaorA.baumannii.Incontrast,penicillin-basedtherapycombinedwithareductioninthird-generationcephalosporinuseappearstolimitbothcolonizationandinfectionwithESBL-producingEnterobacteriaceae. **Slide*IfESBL-producingbacteriaareallowedtoflourishandcauseclinicalinfection,theuseofevenmorebroad-spectrumantibioticswillbenecessary,includingtheuseofcarbapenemagents.AlthoughthisclearlycanleadtocureofagiveninfectioncausedbyanESBL-producingbacteria,severalpublishedreportslinkincreaseduseofcarbapenemantibioticstooutbreaksofmultidrug-resistantP.aeruginosaorA.baumannii.Incontrast,penicillin-basedtherapycombinedwithareductioninthird-generationcephalosporinuseappearstolimitbothcolonizationandinfectionwithESBL-producingEnterobacteriaceae. **头孢哌酮／舒巴坦对不动杆菌的体外活性Study Country Cefoperazone/sulbactam ComparatorsJones,1997 SouthAmerica 83.3% Imipenem95.8%; Colombia ceftazidime70.8% Cefotaxime40.3%Pfaller,1999 Europe 73.8% Imipenem85% Turkey ticarcillin/clavulanicacid29% ceftazidime23.8%Shietal,1996 Asia 99.5% Imipenem97%; Japan piperacillin/tazobactam55.6% piperacillin28% ceftazidime84.4%第64页,共69页，星期六，2024年，5月**头孢哌酮／舒巴坦与头孢哌酮的体外活性比较李家泰,等.中华医学杂志,2003年11期.第65页,共69页，星期六，2024年，5月**HAP实例女，57岁，2004年9月3日入院哮喘13年入院前2天哮喘急性加重，呼吸衰竭，插管、机械通气9月9日顺利脱机／拔管9月11日痰多，呼吸困难加重，再次插管、机械通气9月13日后体温逐渐上升(Tmax39.8oC)，白细胞逐渐升高，最高25.3x109/L，中性粒细胞95.3％经过抗生素治疗后，体温下降、呼吸困难好转，9月