ICU常见的易发感染的疾病及其诊疗思路PPT学习教案

1、会计学1ICU常见的易发感染的疾病及其诊疗思路常见的易发感染的疾病及其诊疗思路第1页/共98页第2页/共98页p重症感染入住重症感染入住ICUICUpICUICU获得感染获得感染 （ICU-acquired infections）pICUICU内获得性感染的预防与控内获得性感染的预防与控制制感染相关问题是ICU永恒主题ICU 工作要点之一是感染第3页/共98页n75 countriesn1265 ICUSn13 796 patientsn7087 (51.4%) infected patientsn9084 (71%) receiving antibioticsnICU mortality r

2、ate 25% (infected) & 11% (non-infected) (P MICAUC/MICCmax/ MICAUC/MICT-D: Time-dependent; C-D: Concentration-dependent第84页/共98页DrugClassDosageEliminationDose adjustmentProtein bindingT 1/2VdLinezolidOxazolidinone 600mg 12hH65%Non-enzyme30%(R)NDose after Dialysis31%4-6h0.8L/kg(40-50L)TigecyclineG

3、lycylcyclines100 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/kgTeicoplaninGlycopeptide4-6mg/kg IV q12h *34-6mg/kg qdR80%R-Y90-95%70-100h0.6L/kg第85页/共9

4、8页DrugT 1/2PAETime/ConcentrationPK/PDPK/PDPK/PDLinezolid4-6hProlongedTAUICTMICAUIC:80-120TMIC40% : Pneumococci 85%: Severe infection 1Tigecycline36hProlongedTAUICTMICAUIC 17.9: cSSTIAUIC 6.96: cIAITMIC 50%Daptomycin8-9hProlongedCAUICCmax / MIC AUIC 189 (Free)Cmax/MIC: 2-4 bacteriocidal Vancomycin4-8

5、hProlongedTAUICAUIC 400Trough level : 15-20 mg/LTeicoplanin 70-100hProlongedTAUICAUIC 125 : Trough level 10 mg/LAUIC 350 : Trough level 20 mg/L1. Bacteraemia, LRTI, skin and skin structure infection第86页/共98页Mayo Clin Proc. 2011;86(8):805-817第87页/共98页M. sinnollareddy, et al. Int J Antimicrob第88页/共98页Pk-Pd of Antifungal Agents第89页/共98页第90页/共98页增加增加单次给药量、给药频率、延长输注时间（单次给药量、给药频率、延长输注时间（Extended/prolonged infusion）；持续输注（）；持续输注（continuous infusion）能够使抗生素血清浓度更大限度保持于能够使抗生素血清浓度更大限度保持于MIC值之上，更有利值之上，更有利于发挥抗生素的抗菌活性，