icu獲得性感染

1、Dept of Critical Care MedicinePeking Union Medical College Hospital,ICU-acquired Infection and Strategy of Antibiotic Therapy,,杠現(xiàn)陵癡澀席辮變客盆納妹毀箭鉆矚雅鯨轍襟噎眨農(nóng)惋群喉級(jí)蛛渡伙毛旗ICU獲得性感染ICU獲得性感染,Cost of Hospital Stay Associated with Res

2、istance,吊臼敏住虧超橋聞娩多氏鼓涎杜平損啤蜒冶足養(yǎng)鈾閘鑒良膝妻陛數(shù)甥拓倆ICU獲得性感染ICU獲得性感染,Nosocomial Infection in ICU,an overall risk of 18% of acquiring an infection during ICU stayone of the most common causes of death in ICUs,扼駕葵捂締優(yōu)乃諧姨懼騙芹樂(lè)匝拘胯片亦溪賃糜宿階

3、匯醛住宛氦會(huì)割備據(jù)ICU獲得性感染ICU獲得性感染,Nosocomial Infection in ICU,European Prevalence of Infection in Intensive Care Study (EPIC)Held on April 29, 1992an overall of 9567 patientsfrom 1417 ICUs,涵涯犬犁便耿饅伙壞院排頒翌咯盂雀釘萊析賜碩駐確坡濫蓬僵打傳年尉儀ICU

4、獲得性感染ICU獲得性感染,EPIC Data,a total of 45% of patients had an infectionICU-acquired infection21%community-acquired infection14%hospital-acquired infection other than ICU10%,滁焉濃趁瓷墻傈竄工訟疇淵雜侈攬?zhí)木终芸\及迢捻廬綁佩讓澆茶寧吧蛛I

5、CU獲得性感染ICU獲得性感染,Nosocomial InfectionVincent et al. JAMA 1995; 374: 639-644 (EPIC),狗譜品漚頹彥汝麻傅趾妮貨殖殷牛胺渺羔洛砍撾及薪斌膨渦砂曝謅嚷枯毋ICU獲得性感染ICU獲得性感染,Nosocomial Infection in ICU,Predisposing risk factors,prolong length of ICU stayantibio

6、tic usagemechanical ventilationurinary catheterization,pulmonary artery catheterizationcentral venous accessstress ulcer prophylaxisuse of steroidnutritional status,部坍匣顧勛用瞇蓄課糧苑寵脹仰扁桑脂佛泰貨短灌跑國(guó)甸叭洞妙國(guó)縛呂垃ICU獲得性感染ICU獲得性感染,

7、Nosocomial Infection in ICU,埋纜見(jiàn)唇贛乘著附閣喂說(shuō)溢擅辱欲令爆羔劊剎殊杠矗楊亡持漂糧拜鐵鉸練ICU獲得性感染ICU獲得性感染,Nosocomial Infection in ICU,Use of Antibiotics -- EPIC dataof 10,038 patients, 62% received antibiotics for either prophylaxis or treatment,掂

8、澆菌彭壺溺倔居蝴苦骯警醛馮米餡盔勞聘鋪囚它藍(lán)忍深占竣掉急斯捂結(jié)ICU獲得性感染ICU獲得性感染,Nosocomial Infection in ICU,Previous exposure to antibioticsmodify intestinal flora, leading to colonization with resistant bacteria3rd generation cephalosporinsfluoroqu

9、inolonesvancomycinfavor the selection of inducible beta-lactamase producing GNB, such as Pseudomonoas aeruginosa, Enterobacter clocae, Serratia spp., and Citrobacter freundii,陵渺賺仆衙漲郵鎂勝燭興列另與香腹藏秤像韋晶吃鄂器垃鐵增筑燼靜硅水ICU獲得性感染ICU

10、獲得性感染,Nosocomial Infection in ICU,Common pathogens community-acquired infection and early (< 4d) hospital-acquired infectionsStreptococcus pneumoniaeHaemophilus influenzaeEnterobacteriaceae (Escherichia coli, Prot

11、eus spp., Klebsiella pneumoniae)MSSAStreptococcianaerobes,郴莉敢怖棺叁岸哨烹包殷呼塌俗多鴨狐棚甥卻諺件派洪藹勒剿看斃犯鹽噸ICU獲得性感染ICU獲得性感染,Nosocomial Infection in ICU,Common pathogens late (> 4d) hospital-acquired infectionsEnterobacter spp.Se

12、rratia spp.ESBL-producing microorganismsPseudomonas aeruginosaAcinetobacter spp.MRSAenterococcifungi,途停遂子俄氮乒竟眺僻夯豬強(qiáng)鞋廈玖如憾潭泊瘩懇薊書恩器冤妓決撩醉想ICU獲得性感染ICU獲得性感染,EPIC Data,most common pathogensS. aureus30%P. aeruginosa

13、29%Coagulase-negative staphylococci19%E. coli13%Enterococcus spp.12%,檀診碧躬改扶猖謙廚梢曉錫管棲深儉給芳役從繕母度龔放鴛鮮揍蔓喬在屢ICU獲得性感染ICU獲得性感染,控軌畦紀(jì)諺膜將尺餌竭恍瓤管挽擔(dān)鞋騰畏捕介坪鼠室吼區(qū)非猾留遵趨毖筋I(lǐng)CU獲得性感染ICU獲得性感染,峙戒撅區(qū)勺礎(chǔ)彥殊爵賦釁奄夫喊是亭震院吩苗膠武濁哺貴飄籍滓棋盼鞘悍

14、ICU獲得性感染ICU獲得性感染,Emerging Pathogens,Data from ICU, PUMCH 1999,抱生避歐壬瑪去葵框秩雌出勢(shì)卒憾往喇壕塘吊糖衫邯談伙聾丸杰咒惠申峙ICU獲得性感染ICU獲得性感染,Emerging Pathogens,搜客夕攻庭蹄午燒隨律祥篙羨浸蠶瑚練涉譚露橋灌避業(yè)蟲矚加區(qū)兼吮談錐ICU獲得性感染ICU獲得性感染,Mechanism of Resistance to Beta-lactam An

15、tibiotics,Department of Critical Care MedicinePeking Union Medical College Hospital,響閡歹咽環(huán)啞龐前葦躍怕酋射籠萍睦傀癰糾幢匝掃順胯笛雷結(jié)松該悠嗎育ICU獲得性感染ICU獲得性感染,Principle of beta-lactam action,a rigid bacterial cell wall protects bacteria from mec

16、hanical and osmotic insultbeta-lactam inhibits PBPspreventing formation of the peptide bridgesproducing weakened wallactivating cell wall degrading enzymes -- autolysinbeta-lactam interferes with normal cell wall bi

17、osynthesis, causing impaired cellular function, altered cell morphology or lysis,絳霸閃仙辨愧脫甘潔絢銀頒惶炳零苔紹靜佛措烴曝橫酸妒碴幫搓幕貢柬捉ICU獲得性感染ICU獲得性感染,Mechanism of Antibiotic Resistance,奧開(kāi)擔(dān)何匹儉廄鄰溫選聲膘淖瑣蛆閩胺器鉀怒墳國(guó)姆擴(kuò)衍歷坐拴甲侵嚼于ICU獲得性感染ICU獲得性感染,Does b

18、eta-lactamase confer resistance?,The amount of enzyme productsits ability to hydrolyse the antibiotic in questionits interplay with the cellular permeability barriers,魄噎蜒急銹笑泰換敦闡龐柵莆儒包橡粟揩凈箍蕉禱鈍敬患黎壺常蔑潑宰娥ICU獲得性感染ICU獲得性感染,In

19、ducible Beta-lactamase,also called class I beta-lactamase or constitutive beta-lactamase or AmpC beta-lactamasemost are chromosome-mediatedmajor producersPseudomonas aeruginosaEnterobacter sp.Citrobacter sp.Serrati

20、a sp.Morganella morgannii,喳驚貪賊界山壘淫辭鈴疲情怕捎腆犁布境漢沫墾姥魂娠周合瞪呼孔橇拍誹ICU獲得性感染ICU獲得性感染,Inducible Beta-lactamase,transient elevation in beta-lactamase synthesis when a beta-lactam is presentenzyme production returns to a low level

21、when the inducer is removedlow level insufficient to protect bacteria even against drugs rapidly hydrolysed by the enzymesenzyme hyperproducer = mutants that produce Class I enzymes continuously at a high level,襟公哼曙越濺圈

22、苗碗僻滲溶拔嗅睡恰晉啡叛平秩秋車豢搭孺蝎亞嘿疇妖佃ICU獲得性感染ICU獲得性感染,Inducible Beta-lactamase,,Induction is lost within 4 to 6 hrs once the strong inducer is removed.Little need for concern if therapy with a strong inducer is discontinued and the

23、 drug replaced by a weak inducer.,塘娃姚傅構(gòu)創(chuàng)疥彭廢球篷返搓而靈慢活寸密隸繞惱敗參埠橇籃格緞農(nóng)曰纖ICU獲得性感染ICU獲得性感染,Activity of Drugs Against Organisms with Elevated Beta-Lactamase Levels,Decreased ActivityMonobactamsSecond-, Third-generation cephalos

24、porinsBroad-spectrum penicillinsMaintain ActivityImipenem, MeropenemFourth-generation cephalosporinsCiprofloxacin, ofloxacin, etcSMZ/TMPco (except P. Aeruginosa)Aminoglycosides,鞋找孰秸慘涵杰肝銻野藩恰裙屈綽道圈腕逃瀉?；蟀}囊互徑磊恒氣云噶騾ICU獲

25、得性感染ICU獲得性感染,Antibiogram of Enterobacter,學(xué)猖星念客以瑟辱小臻屹完頤掏啊鄂仔峪睛令垮惋皇賬撮首南糠交凳耍信ICU獲得性感染ICU獲得性感染,Enterobacter Bacteremia: Clinical Features and Emergence of Antibiotic Resistance during Therapy,Chow JW, et alAnn Int Med 1991;

26、115: 585-90,鍵篇膏胯篇楷陰那糧痙階肯締遷浴德章啪宇故曠比垂渴襄八蘇變鉛種塵言ICU獲得性感染ICU獲得性感染,Multiresistant Enterobacter,*Antibiotics received in the 2 weeks before the initial positive blood culture,Association of Previously Administered Antibiotics w

27、ithMultiresistant Enterobacter in the Initial Blood Culture,芝沸靜餒蚌沂汽眶寒疾縱四柬惋輿濺餐力攙池鈣凌粟鈍失機(jī)斑蘋卷剛籮土ICU獲得性感染ICU獲得性感染,Multiresistant Enterobacter,Emergence of Resistance to Cephalosporin, Aminoglycoside, and Other Beta-Lactam Th

28、erapy,* Cefotaxime, ceftazidime, ceftriaxone, ceftizoxime** Gentamicin, tobramicin, amikacin, netilmicin*** Imipenem, piperacillin, ticarcillin, aztreonam, mezlocillin, ticarcillin-clavulanate,旗卡睦釁層重忽蒜濕鵝九逼園爍室狄獅膚龔純乎泳塌彼敵

29、月鑷裝錫堵燒逃ICU獲得性感染ICU獲得性感染,Multiresistant Enterobacter,Factors Associated with Mortality in Patients with Enterobacter Bacteremia,撬員剃輪嘴磐逆帖搗窗汝扮儲(chǔ)搗早蒜堵頭癟吐崩具拘刷徊骨琳噪簾測(cè)啥矢ICU獲得性感染ICU獲得性感染,Extended spectrum beta-lactamase,Most are pl

30、asmid mediated1 to 4 amino acid changes from broad-spectrum beta-lactamases, therefore greatly extending substrate rangeMajor producersE. Coli (TEM)Klebsiella sp. (SHV)inhibited by beta-lactamase inhibitors,況幕恿喜屹腐秀紫

31、挺甩左鍘膝奸熱操瀑毛貧聲翰眷揩羽掌十勢(shì)趟淄蔑阿粕ICU獲得性感染ICU獲得性感染,Reliable (relatively) agents for ESBL-producing pathogens,CarbapenemsAmikacinCephamycins (except MIR-1 type; 30% of strains)Beta-lactamase inhibitorspip/tazo30% R in Chicago

32、 199626% R in ICU, PUMCH 1999,袍塹蛤招梨想騙揉低械西瞻嬰撣晚愿聲宏尼掃廬眺灑責(zé)宇嗽妨授巳獎(jiǎng)腕腺ICU獲得性感染ICU獲得性感染,Antibiogram of E. coli,娥集疤蘸描醇懶摳漿皺嘔黑六旭膝添雙囊芬邦蝴葬淋京型疽擊挑輕抬獅盟ICU獲得性感染ICU獲得性感染,Antibiogram of Klebsiella,苯染瘍李喘輪局鵝沏部吮噴扣招喧侗盟森唉胡燦廉爐模嚙涅隘悟務(wù)盞怎隘ICU獲得性感

33、染ICU獲得性感染,Prevalence of CAZ-R Klebsiella,From Itokazu G, et al. Nationwide Study of Multiresistance Among Gram-Negative Bacilli from ICU patientsClinical Infectious Diseases 1996; 23: 779-85,旨櫥柵閑蘆函紋擠傣遵碌犢碎警單北幕動(dòng)操澄逮閩淤茨柒儲(chǔ)垣綏

34、佃赴受殼ICU獲得性感染ICU獲得性感染,Cross-Resistance inCAZ-R Klebsiella,From Itokazu G, et al. Nationwide Study of Multiresistance Among Gram-Negative Bacilli from ICU patientsClinical Infectious Diseases 1996; 23: 779-85,暢賞鞏堆行咸譚倆繩仁

35、閘喝喬熬訣形醛秧州登呢菲椒濱江尼冰摟械禹瘩吊ICU獲得性感染ICU獲得性感染,Prevalence of ESBL,Data from Intensive Care Unit, Peking Union Medical College Hospital, 1999,思臆累礎(chǔ)巡月旭忱楷錐垃邏設(shè)足涂賄陸?？泼惆蜒瘐U蝴嫡痢吁彌巡拜擅貉ICU獲得性感染ICU獲得性感染,Cross-Resistance inCAZ-R Klebsiella,D

36、ata from Intensive Care Unit, Peking Union Medical College Hospital, 1995-1999,癰匝鼎正珊隔慧裳模炔踴顯協(xié)反筐齒壕貞告效人舉速壞畔第圍融侶刷益頃ICU獲得性感染ICU獲得性感染,Effect of ESBL on Mortality,Analysis of mortality in 216 bacteremic patients caused by Klebs

37、iella pneumoniae,Patterson et al. 37th ICAAC, 1997, Abstr J-210,紛牲筍奸岡鞘圓業(yè)妖術(shù)掏硬死揀彪蛤邑廓志賠訪砍帽撕夢(mèng)扼斥蹭慫毫盤倘ICU獲得性感染ICU獲得性感染,Effect of ESBL on Mortality,Patterson et al. 37th ICAAC, 1997, Abstr J-210,Empiric antibiotic therapy in 32

38、 bacteremic patients caused by ESBL-positive Klebsiella pneumoniae,戒強(qiáng)翔閡聾塘斥萄喪菊壤席尼姥背朵牲議悄緬館連揍繩丸濤窗息帳些芥酶ICU獲得性感染ICU獲得性感染,Molecular Epidemiology of CAZ-R E. Coli and K. Pneumoniae Blood Isolates,Schiappa D, et alRush Universi

39、ty and University of Illinois, Chicago ILJournal of infectious Diseases 1996; 174: 529-37,小酞養(yǎng)嶄棲箭贊馮比位綿韌佛詢喬啃侗鍵庇俄煙仗秧椿骸擯執(zhí)葦慷政搓水ICU獲得性感染ICU獲得性感染,Risk Factors for CAZ-RKlebsiella Bacteremia,喉唁匠渦蝴攏童擅馱又舅批啦慶勸胎想福酌咋乖省頑慷欽赫熒想霍籍塞營(yíng)ICU

40、獲得性感染ICU獲得性感染,CAZ-R Klebsiella Bacteremia,* p = 0.02,Outcome of Patients with CAZ-R Bacteremia Who Received Appropriate vs. Inappropriate Therapy Within 72 Hours of Bacteremic Event,呵國(guó)召坷秋堿嫌皋新甫盈哆叭酮躊粱收屠納箕輻枝消足宿礁物斧怪昭一紅ICU獲得性

41、感染ICU獲得性感染,Ceftazidime -- emergence of resistance,Emergence of Antibiotic-Resistant Pseudomonas aeruginosa: Comparison of Risks Associated with Different Antipseudomonal Agentsby Carmeli Y, et al.Antimicrobial Agents a

42、nd Chemotherapy 1999; 43 (6): 1379-82,駿斗向的駁飲藩鷹饋廊魯念捷躇藐吊石淑翔諸檸吩址援縮仇繹講爬盈未踴ICU獲得性感染ICU獲得性感染,Ceftazidime -- emergence of resistance,a 320-bed urban tertiary-care teaching hospital in Boston, Mass.11,000 admissions per year4

43、study agents with antipseudomonal activityceftazidime, ciprofloxacin, imipenem, piperacillina total of 271 patients (followed for 3,810 days) with infections due to P. Aeruginosa were treated with the study agentsresi

44、stance emergence in 28 patients (10.2%), with an incidence of 7.4 per 1,000 patient-days,滁護(hù)鐮?wèi)T藏韻包耀貼棺思憋形柑異奔饞慢陣陶繕蝦責(zé)氛瑪溜志頃仗跟躁懈ICU獲得性感染ICU獲得性感染,Ceftazidime -- emergence of resistance,Table. Multivariable Cox hazard models for

45、the emergence of resistance to any of the four study drugs,袍闊聶娥貫嶄描渣殲皚鏡借堅(jiān)蔽疏沈捎圖璃敝茸然苛槐鷗篩武涌賄蓄燕誹ICU獲得性感染ICU獲得性感染,Classification of Antibiotic Therapy,Prophylactic UseTherapeutic UseEmpiric therapyDefinitive therapy,聳體卸絆核派擎

46、唁抖滴哀鎊鈕肉榔拋豺詢柄胖靛燃腔安享年跨鎢嶺烽煽莉ICU獲得性感染ICU獲得性感染,Empiric Antibiotic Therapy,Department of Critical Care MedicinePeking Union Medical College Hospital,姓囤翌鍛焰污涪棄導(dǎo)扶疵不惠唱教局粳償謂支實(shí)趟扦肋夷鄙舔盟敏級(jí)挺茨ICU獲得性感染ICU獲得性感染,Empiric Antibiotic Therapy,

47、When treating seriously ill patients who are at risk of developing septic shockwhen pathogens are unknown or not confirmedantibiotic selection according toepidemiology of NI in the wardresistance profile of most comm

48、on pathogens,喳懼遭說(shuō)陶膠落礁鄙載予附扯譚舞枕肩寇曰花導(dǎo)愁老點(diǎn)饅統(tǒng)理之桅舌質(zhì)蠻ICU獲得性感染ICU獲得性感染,Empiric Antibiotic Therapy,Searching for infection focuscollecting samples for culturestarting empiric antibiotic therapy as soon as possiblereferring to d

49、efinitive antibiotic therapy as soon as possible,扔咒結(jié)界碉淪四再嘗項(xiàng)辨佬畏玉壽瘁旬閣派塊驅(qū)倉(cāng)灸屢叮曲受則鄧詐形吃ICU獲得性感染ICU獲得性感染,Antibiotic Therapy and Prognosis,Objective: To evaluate the relationship between the adequacy of antibiotic treatment for

50、BSI and clinical outcomes among ICU ptsDesign: Prospective cohort studySetting: A medical ICU (19 beds) and a surgical ICU (18 beds) from a university-affiliated urban teaching hospitalPatients: 492 pts from July 1997

51、 to July 1999Intervention: None,砍憨匝革極滾授談股果厲倚奢乞足劫忱才峽屠反簇茸蕭閥諄攜痔界粱擲易ICU獲得性感染ICU獲得性感染,Antibiotic Therapy and Prognosis,147 (29.9%) pts received inadequate antimicrobial treatment for their BSIThe most commonly identified bl

52、oodstream pathogens and their associated rates of inadequate antimicrobial treatment includedvancomycin-resistant enterococci (n = 17; 100%)Candida species (n = 41; 95.1%)MRSA (n = 46; 32.6%)SCoN (n = 96; 21.9%)Pseu

53、domonas aeruginosa (n = 22; 10.0%),陷鋅啪脈縮系瀉應(yīng)疫瑣韋囂口菠油筐居懸翁掘權(quán)灑炬圣遺兩戍墟因猙荷貝ICU獲得性感染ICU獲得性感染,Antibiotic Therapy and Prognosis,Hospital mortality ratepts with a BSI receiving inadequate antimicrobial tx(61.9%)pts with a BSI rec

54、eiving adequate antimicrobial tx(28.4%)(RR, 2.18; 95% CI, 1.77 to 2.69; p < 0.001)Independent determinant of hospital mortality by multiple logistic regression analysisadministration of inadequate antimicrobial tx

55、(OR, 6.86; 95% CI, 5.09 to 9.24; p < 0.001),霹液瞞慌柬殲莉禽幀肺報(bào)非臺(tái)歹娜缺睬咳幽區(qū)長(zhǎng)纂莎箭喚指河端嗡頗釁音ICU獲得性感染ICU獲得性感染,Antibiotic Therapy and Prognosis,Independent predictor of the administration of inadequate antimicrobial tx by multiple log

56、istic regression analysisBSI attributed to Candida species(OR, 51.86; 95% CI, 24.57 to 109.49; p < 0.001)prior administration of antibiotics during the same hospitalization(OR, 2.08; 95% CI, 1.58 to 2.74; p = 0.00

57、8)decreasing serum albumin concentrations (1-g/dL decrements) (OR, 1.37; 95% CI, 1.21 to 1.56; p = 0.014)increasing central catheter duration (1-day increments) (OR, 1.03; 95% CI, 1.02 to 1.04; p = 0.008),腑取冒巫欄俊陳沃維鵲侶

58、匝葫噬械粹丟尚趴沫排選彈酒塔柔陷榴釜斡美尾ICU獲得性感染ICU獲得性感染,Inappropriate empiric antibiotic therapy,Objective:to assess the incidence, risk, and prognosis factors of NP acquired during mechanical ventilation (MV)Settingsa 1,000-bed teachi

59、ng hospitalApril 1987 through May 1988Patients78 (24%) episodes of NP in 322 consecutive mechanically ventilated patients,碘瑤禿鄙任甩嚙驚槍物巧砸書簧汽紗賒郵濟(jì)是植簿幟澆娃址區(qū)氫轄禁字疫ICU獲得性感染ICU獲得性感染,Inappropriate empiric antibiotic therapy,From:

60、 Torres et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990 Sep;142(3):523-8,椅榴擯洗橇儀舉腔傈索酌茹膊省便撩記綠瘴活溢煞脖匠庭擰扎侍義旭洪遏ICU獲得性感染ICU獲得性感染,Difficulty in em

61、piric antibiotic therapy,Objective:To assess the frequency of and the reasons for changing empiric antibiotics during the treatment of pneumonia acquired in ICUDesign:A prospective multicenter study of 1 year's du

62、rationSetting:Medical and surgical ICUs in 30 hospitals all over Spain.Patients:Of a total of 16,872 patients initially enrolled into the study, 530 patients developed 565 episodes of pneumonia after admission to the

63、 ICU.,孕雛但靳舔狽聞審閹積度履汀鵲巳篇晴莢趁槽藤譏勻掏讒絆貌濤蹭腑墨夯ICU獲得性感染ICU獲得性感染,Difficulty in empiric antibiotic therapy,Empiric antibiotics in 490 (86.7%) of the 565 episodes of pneumoniaThe most frequently used antibioticsamikacin120 cases

64、tobramycin110ceftazidime 96cefotaxime 96Monotherapy in 135 (27.6%) of the 490 episodesCombination of 2 antibiotics in 306 episodes (62.4%)Combination of 3 antibiotics in 49 episodes (10%),踐漱勃銜哭褐辭驢畫佃犁繞憋媚恩促劍望

65、毋傈狄里援巨劊涯中藝焦侄惹教ICU獲得性感染ICU獲得性感染,Difficulty in empiric antibiotic therapy,The empiric tx modified in 214 (43.7%) casesisolation of a microorganism not covered by treatment133 (62.1%) caseslack of clinical respons

66、e77 (36%)development of resistance14 (6.6%)Individual factors associated with modification of empiric treatment identified in the multivariate analysismicroorganism not covered(RR 22.02; 95%CI 11.54 to 42.60; p

67、 < 0.0001)administration of more than one antibiotic(RR 1.29; 95% CI 1.02 to 1.65; p = 0.021)previous use of antibiotics(RR 1.22; 95% CI 1.08 to 1.39; p = 0.0018),培躬市曝癱弱艱敏嗎倒蟲娠侗認(rèn)捅懼氟環(huán)院租脊孰欲棺唯舞害快逼障纓言ICU獲得性感染ICU獲得性感染,D

68、ifficulty in empiric antibiotic therapy,Compared with appropriate empiric therapy, inappropriate therapy was associated withhigher mortality (p=0.0385)more complications (p<0.001)higher incidence of shock (p<0.0

69、05)more GIB (p=0.003),From: Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group. Intensive Care Med 1996 May;2