icu感染的治疗ppt课件.pptx

ICU感染的治疗北京协和医院杜 斌ICU感染: 患病率医院获得性感染的患病率为5 – 30%ICU患者感染的患病率约为18 – 50%较普通患者高3 – 18倍ICU床位 = 医院总床位数的5%医院获得性感染 = 25%Spencer RC. Epidemiology of infection in ICUs. Intensive Care Med 1994; 20: S2-6.Bates DW, Miller EB, Cullen DJ, et al. Patient risk factors for adverse drug events in hospitalized patients. ADE Prevention Study Group. Arch Intern Med 1999; 159: 2553-60.Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest 2000; 117: 1496-9.ICU危重病患者的感染European Prevalence of Infectionin Intensive Care Study (EPIC)1992年4月29日进行1417个ICU参加总计9567名ICU患者ICU危重病患者的感染ICU感染的组成EPIC内科外科ICUNNISPUMC下呼吸道感染2418652753泌尿系感染433118205手术部位感染1112916血行性感染151022112其他1830132014感染对患者预后的影响增加住院日额外医疗费用手术部位感染7.33,152肺炎5.95,683血行性感染7.43,517泌尿系感染1.0680总计4.02,100ICU血行性感染: 致病菌ICU获得性肺炎: 致病菌NNISPUMCHICU感染的致病菌耐药菌NNIS (1996 – 2000)北京协和医院ICU(1995 – 2000)平均耐药率 (%)10%百分位数90%百分位数MRSA46.515.466.787MRSE74.956.986.795亚胺培南耐药的铜绿假单胞菌16.70.031.327头孢他啶耐药的铜绿假单胞菌11.70.025.028哌拉西林耐药的铜绿假单胞菌15.00.031.638三代头孢菌素耐药的肠杆菌25.910.050.954亚胺培南耐药的肠杆菌0.90.04.05三代头孢菌素耐药的肺炎克氏菌5.40.018.522三代头孢菌素耐药的大肠杆菌0.90.06.517氟喹诺酮耐药的大肠杆菌4.20.011.167Du B, Chen DC, Liu DW, Xu YC, Xie XL, Chen MJ. Natl Med J China 1996; 76: 262-6.Li Y, Du B, Chen DC, Liu DW. Beijing Med J 2002; 24: 3-5Du B. Natl Med J China 2001; 81: 1278-80ICU中重度感染的危重病患者最初不充分抗生素治疗的病死率*最初充分治疗Alvarez-Lerma,1996Rello, 1997最初不充分治疗Kollef, 1999Kollef, 1998Ibrahim, 2000Luna, 1997病死率*0%20%40%60%80%100%*病死率指总病死率或感染相关病死率Alvarez-Lerma F et al.Intensive Care Med 1996;22:387-394.Rello J et al. Am J Respir Crit Care Med 1997;156:196-200.Kollef MH et al. Chest 1999; 115:462-474Kollef MH et al. Chest 1998;113:412-420.Ibrahim EH at al. Chest 2000;118:146-155.Luna CM et al. Chest 1997;111:676-685.ESBL阳性菌感染不适当抗生素治疗与病死率OR = 4.701P = 0.0167/1414/71Bin Du, Yun Long, Hongzhong Liu, Dechang Chen, Dawei Liu, Yingchun Xu, Xiuli Xie. Extended-spectrum beta-lactamase-producing-Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome. Intensive Care Med 20