ICU常見的易發(fā)感染的疾病及其診療思路-M3-課件

1、ICU常見的易發(fā)感染的疾病及其診療思路-M3-文檔資料單擊此處添加副標(biāo)題ICU常見的易發(fā)感染的疾病及其診療思路-M3-文檔資料ICU常見的易發(fā)感染的疾病及其診療思路-M3-文檔資料單擊此處添加副標(biāo)題ICU常見的易發(fā)感染的疾病及其診療思路Jianguo Tang Trauma-Emergency-Critical Care Medicine Center (T-E-CCMC)你好ICU常見的易發(fā)感染的疾病及其診療思路Jianguo Tang Trauma-Emergency-Critical Care Medicine Center (T-E-CCMC)內(nèi)容提要ICU常見的易發(fā)感染的疾病ICU獲

2、得性感染病原特征ICU常見的易發(fā)感染病原學(xué)ICU常見感染抗生素選擇策略ICU常見感染抗生素應(yīng)用要點(diǎn)內(nèi)容提要ICU常見的易發(fā)感染的疾病ICU獲得性感染病原特征ICU常見的易發(fā)感染病原學(xué)ICU常見感染抗生素選擇策略ICU常見感染抗生素應(yīng)用要點(diǎn)ICU 感染患者感染性疾病診治感染的預(yù)防與控制重癥感染入住ICUICU獲得感染 （ICU-acquired infections）ICU內(nèi)獲得性感染的預(yù)防與控制感染相關(guān)問題是ICU永恒主題ICU 工作要點(diǎn)之一是感染75 countries1265 ICUS13 796 patients7087 (51.4%) infected patients9084 (71

3、%) receiving antibioticsICU mortality rate 25% (infected) & 11% (non-infected) (P MICAUC/MICCmax/ MICAUC/MICT-D: Time-dependent; C-D: Concentration-dependentPk-Pd of newest antimicrobial agents for resistant GPCDrugClassDosageEliminationDose adjustmentProtein bindingT 1/2VdLinezolidOxazolidinone 600

4、mg 12hH65%Non-enzyme30%(R)NDose after Dialysis31%4-6h0.8L/kg(40-50L)TigecyclineGlycylcyclines100 mg IV,50mg q12hBiliary 60%R20-40%(Unchanged)H-Y71-89%36h10L/kgDaptomycin Lipopeptide46 mg,-10mg/kg qdR78%R-Y92%8-9h0.1L/kgVancomycinGlycopeptide15-20mg/kg IV q8-12hR80-90%R-Y10-55%(30%)4-8h0.3L/kgTeicopl

5、aninGlycopeptide4-6mg/kg IV q12h *34-6mg/kg qdR80%R-Y90-95%70-100h0.6L/kgPk-Pd of newest antimicrobial agents for resistant GPCDrugT 1/2PAETime/ConcentrationPK/PDPK/PDPK/PDLinezolid4-6hProlongedTAUICTMICAUIC:80-120TMIC40% : Pneumococci 85%: Severe infection 1Tigecycline36hProlongedTAUICTMICAUIC 17.9

6、: cSSTIAUIC 6.96: cIAITMIC 50%Daptomycin8-9hProlongedCAUICCmax / MIC AUIC 189 (Free)Cmax/MIC: 2-4 bacteriocidal Vancomycin4-8hProlongedTAUICAUIC 400Trough level : 15-20 mg/LTeicoplanin70-100hProlongedTAUICAUIC 125 : Trough level 10 mg/LAUIC 350 : Trough level 20 mg/L1. Bacteraemia, LRTI, skin and sk

7、in structure infection抗真菌藥物的Pk-PdMayo Clin Proc. 2019;86(8):805-817抗真菌藥物的Pk-PdM. sinnollareddy, et al. Int J Antimicrob Agents(2019), doi:10.1016Pk-Pd of Antifungal Agents-lactams; Carbapenems增加單次給藥量、給藥頻率、延長(zhǎng)輸注時(shí)間（Extended/prolonged infusion）；持續(xù)輸注（continuous infusion）能夠使抗生素血清濃度更大限度保持于MIC值之上，更有利于發(fā)揮抗生素的抗菌活性，保證臨床療效。Pk changes in critically ill patientsICU常見感染抗生素應(yīng)用要點(diǎn)Get it right the first timeHit hard upfront Broad-spectrum antibiotics (appropriate spectrum) Short period /duration De-escala