《current evidence and considerations in the management plicated infections》PPT课件.ppt

David P. Nicolau, PharmD, FCCP, FIDSA
Director,
Center for Anti-Infective Research and Development
Hartford Hospital
Hartford, CT
Current Evidence and Considerations in the Management plicated Infections
Disclosures
I am a consultant or member of the speakers bureau or have received research grant funding from AstraZeneca, Cerexa, Cubist, Forest, Johnson & Johnson, Merck, Optimer, Pfizer, Tetraphase and Trius.
Improving the Probability of
Positive es
IMPROVING THE ODDS
HOST
BUG
Nicolau DP Am J Man Care 1998:4(10 Suppl) S525-30
Organisms of Concern:
us aureus
i
Enterobacteriaceae
Pseudomonas
obacter
Organisms of Concern:
us aureus  MRSA
i  ycin Resistant
Enterobacteriaceae  ESBL , carbapenemase producing
Pseudomonas and obacter
Shift towards higher MICs
MDR or XDR profiles
Antimicrobial Resistance
Hospital Setting
ICU v. Non-ICU
MRSA
P. aeruginosa  60% isolated outside the ICU [Eagye KJ, Banevicius MA, Nicolau DP. Critical Care Medicine 2012;40(4):1329-1332].
Community Setting
“The munity”
Transitions of Care: Increased introduction of anisms from the nursing home / rehabilitation facilities
Non-institutionalized “The munity”
Increased introduction of anisms from munity “home” setting [CA-MRSA, ESBLs]
Characteristics of Infections due to ESBL-producing BacteriaRisk Factors
Community-onset
Repeat UTIs with underlying renal pathology
Previous antibiotics (cephalosporins, fluoroquinolones)
Previous hospitalization
Nursing-home residents
Older men and women
Diabetes mellitus
Underlying liver pathology
Hospital-onset
Longer length of hospital stay
Severity of illness (more severe, the higher the risk)
Longer time in the ICUs
Intubations and mechanical ventilation
Urinary or arterial catheterization
Previous exposure to antibiotics (cephalosporins, FQ)
Pitout JD and Laupland KB. Lancet Infect Dis 2008;8:159-66.
Antimicrobial Resistance in Gram-negative bacilli
Resistance is plex problem1,2
Expanding mechanisms
Efflux pumps
Permeability changes
Ta