《ICU获得性感染》PPT课件

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1、DeptofCriticalCareMedicinePekingUnionMedicalCollegeHospitalICU-acquiredInfectionandStrategyofAntibioticTherapyCostofHospitalStayAssociatedwithResistanceNosocomialInfectioninICUanoverallriskof18%ofacquiringaninfectionduringICUstayoneofthemostcommoncausesofdeath

2、inICUsNosocomialInfectioninICUEuropeanPrevalenceofInfectioninIntensiveCareStudy(EPIC)HeldonApril29,1992anoverallof9567patientsfrom1417ICUsEPICDataatotalof45%ofpatientshadaninfectionICU-acquiredinfection21%community-acquiredinfection14%hospital-acquiredinfectio

3、notherthanICU10%NosocomialInfectionVincentetal.JAMA1995;374:639-644(EPIC)NosocomialInfectioninICUPredisposingriskfactorsprolonglengthofICUstayantibioticusagemechanicalventilationurinarycatheterizationpulmonaryarterycatheterizationcentralvenousaccessstressulcer

4、prophylaxisuseofsteroidnutritionalstatusNosocomialInfectioninICUNosocomialInfectioninICUUseofAntibiotics--EPICdataof10,038patients,62%receivedantibioticsforeitherprophylaxisortreatmentNosocomialInfectioninICUPreviousexposuretoantibioticsmodifyintestinalflora,l

5、eadingtocolonizationwithresistantbacteria3rdgenerationcephalosporinsfluoroquinolonesvancomycinfavortheselectionofinduciblebeta-lactamaseproducingGNB,suchasPseudomonoasaeruginosa,Enterobacterclocae,Serratiaspp.,andCitrobacterfreundiiNosocomialInfectioninICUComm

6、onpathogenscommunity-acquiredinfectionandearly(<4d)hospital-acquiredinfectionsStreptococcuspneumoniaeHaemophilusinfluenzaeEnterobacteriaceae(Escherichiacoli,Proteusspp.,Klebsiellapneumoniae)MSSAStreptococcianaerobesNosocomialInfectioninICUCommonpathogenslate(>

7、4d)hospital-acquiredinfectionsEnterobacterspp.Serratiaspp.ESBL-producingmicroorganismsPseudomonasaeruginosaAcinetobacterspp.MRSAenterococcifungiEPICDatamostcommonpathogensS.aureus30%P.aeruginosa29%Coagulase-negativestaphylococci19%E.coli13%Enterococcusspp.12%E

8、mergingPathogensDatafromICU,PUMCH1999EmergingPathogensMechanismofResistancetoBeta-lactamAntibioticsDepartmentofCriticalCareMedicinePekingUnionMedicalCollegeHospitalPrincipleofbeta-