院內(nèi)獲得性感染的治療與控制

1、The Impact of Antimicrobial-Resistant Gram-Negative InfectionsThe Impact of AntimicrobialThe Impact of Antimicrobial- -Resistant GramResistant Gram- -Negative InfectionsNegative Infections Resistance to antimicrobial agents is increasing among many gram-negative pathogens1 Infection with resistant p

2、athogens is associated with negative health outcomes3,4 Mortality/morbidity Length of ICU and hospital stay Healthcare costs No new antibiotic classes under development2 Highlights the need to optimize existing classes of antimicrobials1. Gaynes R, et al. Clin Infect Dis. 2005;41:848-854. 2. Spellbe

3、rg B, et al. Clin Infect Dis. 2004;38:1279-1286. 3. Lautenbach E, et al. Infect Control Hosp Epidemiol. 2006;27:893-900. 4. Cosgrove, S et al. Clin Infect Dis. 2006;42:S82-S89. . Percentage of Nosocomial Infections Associated With Selected Pathogens, 2003Percentage of Nosocomial Infections Percentag

4、e of Nosocomial Infections Associated With Selected Pathogens, 2003Associated With Selected Pathogens, 20036.526.03.35.0E coli, %9.06.94.410.0Enterobacterspp, %9.516.33.418.1P aeruginosa, %2.13.0Surgical site infection(n=2984)1.69.8Urinary tract infection(n=4109)2.44.2Bloodstream infection(n=2351)6.

5、97.2Pneumonia(n=4365)Acinetobacter spp, %K pneumoniae, %Type of InfectionData from the National Nosocomial Infections Surveillance (NNIS) System, 2003. Percentages of bacterial ICU isolates are shown.Gaynes R, Edwards JR. Clin Infect Dis. 2005;41:848-854.Boxes indicate most prevalent gram-negative s

6、pecies isolated for type of infection胡必杰、何禮賢、張杏怡等胡必杰、何禮賢、張杏怡等.中華醫(yī)院感染學雜志中華醫(yī)院感染學雜志.2001;11(13):177-180費曉云、胡必杰、李華茵等費曉云、胡必杰、李華茵等.待發(fā)表待發(fā)表長征醫(yī)院、長海醫(yī)院、市一醫(yī)院、市六醫(yī)院、長征醫(yī)院、長海醫(yī)院、市一醫(yī)院、市六醫(yī)院、瑞金醫(yī)院、仁濟醫(yī)院、新華醫(yī)院、肺科醫(yī)院、瑞金醫(yī)院、仁濟醫(yī)院、新華醫(yī)院、肺科醫(yī)院、華東醫(yī)院、中山華東醫(yī)院、中山 醫(yī)院醫(yī)院HAP：醫(yī)院內(nèi)肺炎：醫(yī)院內(nèi)肺炎 HTB：醫(yī)院內(nèi)氣管支氣管炎：醫(yī)院內(nèi)氣管支氣管炎表表1 兩組基線資料比較兩組基線資料比較兩組療效比較兩組療效比

7、較P均均兩組細菌學療效比較兩組細菌學療效比較P均均心臟外科重癥監(jiān)護室鮑曼不動桿菌暴發(fā)感染分子流行病學研究心臟外科重癥監(jiān)護室鮑曼不動桿菌暴發(fā)感染分子流行病學研究郭述良郭述良 何禮賢何禮賢 胡必杰胡必杰 張磊張磊 羅永艾羅永艾48.597.0145.5194.0242.5291.0339.5Kb 35株表型相同菌株染色體株表型相同菌株染色體DNA PFGE圖譜分析結(jié)果圖譜分析結(jié)果細菌（株）細菌（株）GM-PFGE條帶條帶圖示圖示完全相同完全相同13條差異條差異3條差異條差異銅綠假單胞菌（銅綠假單胞菌（n=15）13（5例）例）02（1例）例）圖圖1腸桿菌科腸桿菌科 圖圖2 大腸埃希菌（大腸埃希菌（n=2）002（1例）例）圖圖2 肺炎克雷伯菌（肺炎克雷伯菌（n=2）002（1例）例）圖圖2 陰溝腸桿菌（陰溝腸桿菌（n=5）5（2例）例）00圖圖2肺炎鏈球菌（肺炎鏈球菌（n=2） 2（1例）例） 圖圖3鮑曼不動桿菌（鮑曼不動桿菌（n=5）5（2例）例）00圖圖4金葡菌（金葡菌（n=4）4（2例）例）00圖圖4表表2兩組間細菌胃肺菌株同源率比較兩組間細菌胃肺菌株同源率比較組別組別C 組（組（n36）I 組（組（n31）合計合計菌株同