mdr-西班牙讲稿

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1、MDRGrampositivesinVAP/HAPWhatdoyouexpecttohear?IsORSAVAPanimportantchallenge?What’snewonORSAmicrobialdiagnosis?Howtherapy&organismsaffectoutcomes?ConsiderationsregardingoptimaltherapyNewparadigmS.aureus—TheMostFrequentIsolateinEPICStudyVincentJL,etal.JAMA1995;274:639-644.VincentJL.IntCareMed2000

2、;26:S3-S8.MRSAprevalenceisaseriousprobleminEuropeRatesofhospitalStaphylococcusaureusisolatesthataremethicillin-resistant,basedonsamplesfrominpatient,outpatient,andICUpatients.AdaptedfromEuropeanAntimicrobialResistanceSurveillanceSystem[EARSS]interactivedatabaseresults(2)ETIOLOGYOFVAP:ResultsofE

3、U-VAP/CAPStudy**EndorsedbyESICMPATHOGENSBYCOUNTRYGolanY,etal.,abstract,44thAnnualMeetingoftheIDSA.Toronto.October12-15,2006.MIC(µg/mL)%Isolates‘MICCreep’AmongVancomycin-sensitiveStrainsofMRSAInvitrocomparisonofvancomycinMICsbetween2002and2005atNewEnglandMedicalCenterAdramaticincreaseinMICsforMRS

4、Abloodstreamisolates01020304050600.250.51220022005VancomycinMICsandMRSABacteremia414casesbacteremiaMortalityVancoTxwithMIC2=6.39InappropriateInitialEmpiricTherapy(IIET)=3.62Shock=7.38High(inclPneumo)=3.6orIntermediateRisk=2.18Steroids=1.85Ultimately=10.2orrapidlyfatalunderlyingdisease=1.81Age=1.

5、02/yearSoriano,ClinInfectDis,2008VancomycinMICandClinicalCureofMRSAInfectionsRenalinsufficiencyalsosignificantriskforclinicalfailureSuccessdecreasedapprox20%forevery10ml/mindecreaseinCrClMoise-Broder,CID,2004MRSAbloodstreaminfectionrespondpoorlytovancomycinSusceptibilitybreakpointloweredto<1mg/L

6、Achievingthough>15mcg/mLdidnotimproveoutcomestroughsVancomycinMIC>=1.5mg/LassociatedwithFailure(RR2.4)p=0.05Lodiseetal,AntimicrobAgChemother2008;52:3315InadequateAntimicrobialTherapyAssociatedWithHigherMortalityBloodstreaminfectionsNP/VAP1.IbrahimEHetal.Chest.2000;118:146-155.2.Alvarez-LermaFeta

7、l.IntensiveCareMed.1996;22:387-394.3.RelloJetal.AmJRespirCritCareMed.1997;156:196-200.123DistributionofS.aureusinVAPClass1-MV<7dNoAbs*Class2-MV<7d+AbsClass3-MV7dNoAbsClass4-MV7d+AbsRelloJ,etal.AmJRespirCritCareMed1999;160: