預(yù)防導(dǎo)管相關(guān)性血流感染課件

血流感染實(shí)驗(yàn)室診斷方法新進(jìn)展血流感染實(shí)驗(yàn)室診斷方法新進(jìn)展1主要內(nèi)容血流感染的概念血流感染監(jiān)測及流行病學(xué)3)血流感染相關(guān)生物標(biāo)志物實(shí)驗(yàn)室診斷方法新進(jìn)展5結(jié)束語主要內(nèi)容2血流感染泛指是指病原菌及其毒素侵入血流所引起的一類臨床綜合征。病程中常有炎癥介質(zhì)的激活和釋放,引起高熱、寒戰(zhàn)、心動過速呼吸急促、皮疹和神志改變等一系列臨床癥狀,嚴(yán)重者可引起休克、DC和多器官功能衰竭,死亡率較高。敗血癥(septicemia):病原菌及其毒素侵入血流所引起的臨床綜合征,是種嚴(yán)重的全身感染。病原菌主要是細(xì)菌,也可為真菌、分枝杄菌等菌血癥(bacteremia):菌在血流中短暫出現(xiàn)的現(xiàn)象,一般無明顯毒血癥狀,在國外文獻(xiàn)中常與敗血癥通用腴毒血癥(sepsIs):感染+全身性炎癥反應(yīng),血培養(yǎng)可以陽性或陰性血流感弟(bloodstreaminfection,BS):敗血癥和菌血癥目前統(tǒng)稱為血流感染血流感染3醫(yī)院獲得性血流感染原發(fā)性血流感染:實(shí)驗(yàn)室證實(shí)血流感染(Laboratory-confirmedBloodstreamInfection,LCBD)標(biāo)準(zhǔn):從一次或多次血標(biāo)本中培養(yǎng)出一種一致的致病菌,而且培養(yǎng)出的病原體與其它部位的感染無關(guān)臨床血流感染(ClinicalSepsis)標(biāo)準(zhǔn):具有非其它己知原因所引起的發(fā)燒、血壓過低(收縮壓≤90mmHg或收縮壓低于平常超過40mmHg),少尿(每小時(shí)尿量低于30m)等臨床癥狀任何一項(xiàng),且符合下列所有條件者1未做血培養(yǎng),或血培養(yǎng)陰性或血液抗原反應(yīng)呈陰性者2其它部位無明顯感染者醫(yī)生針對此感染中毒癥狀給予適當(dāng)抗菌藥物治療醫(yī)院獲得性血流感染4繼發(fā)性血流感染血培養(yǎng)分離出有意義微生物,而且此微生物與另一部位之院內(nèi)感染有關(guān)。唯不包括血管或血管內(nèi)導(dǎo)管裝置所引起之血流感染?！錾鐓^(qū)獲得性血流感染antbacteria繼發(fā)性血流感染5血流感染監(jiān)測的重要性■為血流感染的流行病學(xué)提供基本信息,監(jiān)測發(fā)生趨勢和發(fā)生率■為新出現(xiàn)的病原菌或耐藥表型提供早期預(yù)警;監(jiān)測罕見菌的檢測為公共衛(wèi)生決策者進(jìn)一步調(diào)查提供幫助■為臨床醫(yī)生提供反饋信息急血流感染監(jiān)測的重要性6血流感染監(jiān)測歷史Table1.KeyeventsinthehistoryofbloodstreaminfectionmonitoringBacteriainthebloodweredescribedforthefirsttimebytheFrenchphysicianCasimir-JosephDavaine,whbservedbacteriainbloodfromanimalswithanthraxThetermbacteremiawascoinedbyEdmeVulpiantoemphasizethepathogenicroleofthenowacceptedphrase"bacteriaintheblood'(forareviewsee179)Around1900BloodculturinghasbecomeanimportantclinicaltoolatmajorhospitalsworldwideAprospectivenationwideStaphyococcusaureusdatabaseisestablishedatStatensSerumInstitut,Copenhagen1953Langmuirformulatesthemodernconceptofsurveillanceinpublichealth,emphasizingtheroleindescribinghealthofpopulationsMartinmadeapleaforanAmericanNationalBacteremiaRegistry(21)9705and1980sThefirstpopulation-basedstudiesofbloodstreaminfectionwereconductedinNorthCarolina[8081McGowanpublishedsurveillancedatafromBostonCityHospital[82]Weinsteinetal.publishedtwoofthemostinfluentialpapersonbloodstreaminfection(19,20)TheintroductionofmicrocomputersallowsmoreefficientdecentralizationofdataanalysisandelectroniclinkageofparticipantsinsurveillancenetworkslefirstprospectivebacteremiaregistriesweredevelopedatSt.Thomas'sHospital,London[83]andatBeilinsonHospitalinPetahTigva,Israel[84]1990sand2000sTheintemetisusedincreasinglytotransmitandreportdataTheEuropeanAntimicrobialResistanceSurveillanceSystem(EARSS,renamedEARS-Netin2010)waslaunchedil血流感染監(jiān)測歷史7血流感染流行病學(xué)特點(diǎn)革蘭氏陽性菌感染呈上升趨勢,特別是凝固酶陰性葡萄球菌、腸球菌■真菌血流感染發(fā)病率逐年上升■革蘭陰性菌感染下降■耐藥菌比例逐年增加廣譜耐藥菌株(VRE、MRSA/MRSE、V|SAVRSA■社區(qū)獲得與醫(yī)院獲得血流感染病原譜存在差異■院內(nèi)BS患者病死率高血流感染流行病學(xué)特點(diǎn)8腫瘤患者血流感染流行病學(xué)趨勢Table1Distnbutionofetiologicagentisolatedfrombacteremiampatientswithcancerinpublishedstudiessinee2008Characteristic/agentfanetal.Cattaneoetal.anderetal.Chongetal.ingetaL,Gudioletal2012[201Studyperiod2001-20062014-20102002-2008200620092006-207,2008-200820062010SwedenSouthkoreaProplylaxisNotreporledNotrepartedNoprophylaxisNoproplylaxisNoprophylaxisNoprophylaxi凸comOrosengi圖m4.7%3.6%Ns17.8%186%netohactersKlebsiella11.6%Ns85%NS3.5%4.7%1.7%NsNNS44%45.5%amlase-ncgntivesaphylococcIyNS83%5.1NS5.8%9.2%Srepsococciasspp55%Ns64%34%epsocbcci.spuelo/me3.5%Ns14%23%EurJClinMicrobiolInfectDis(2013)32:841-850腫瘤患者血流感染流行病學(xué)趨勢9TablAntibioticsusceptibilityamongbuctcramicisolatesinpatientswithcancerinpublishedstudiessince2008antibioticIrfanetaL.20086Killanderetal,Chongetal.ecarichietal.BhusaletalMihuetalStudyperiod2001-20062012-2008206-2009200-20719992008SwedenledstatasedstatesProphylaxisNoprphylaxisNoprophylaxis51.b%recededeaduseofquinoloneWidespreaduseofquinolonequinoloneCeftazidime94.1%(Psedowwasaenginosa)95%58.1%(Ecoli)NSNS3%(EnterobacteraceaeP'iperacilm-wohactamNSNS37.1%(Ecoli)NS98%(E.cmNSImipenemcilastatin871%100%(Ecoli)NSTicamcillim-clavulemateNSNSNSNArmoxycillin-clasulamate519%(Enterobacteriaceae)64.5%(Ecwi)44%GN816%E95%(E.antiAmikacinGentamicin76112%(GP)NS4%(Ec)955%(Eci60%(E:coiprofkxacin84%(c)12%cm11%(Ea)55%ch69.8%(StainoeecsawEus)NSNSNSNSNSNvaneomycin'leipoplanin87%(EnermcaccussppiGNGnim-negativemicroorganism,GPGrampositivemicroorganismEurJClinMicrobiolInfectDis(2013)32:841-850TablAntibioticsusceptibility10預(yù)防導(dǎo)管相關(guān)性血流感染課件11預(yù)防導(dǎo)管相關(guān)性血流感染課件12預(yù)防導(dǎo)管相關(guān)性血流感染課件13預(yù)防導(dǎo)管相關(guān)性血流感染課件14預(yù)防導(dǎo)管相關(guān)性血流感染課件15預(yù)防導(dǎo)管相關(guān)性血流感染課件16預(yù)防導(dǎo)管相關(guān)性血流感染課件17預(yù)防導(dǎo)管相關(guān)性血流感染課件18預(yù)防導(dǎo)管相關(guān)性血流感染課件19預(yù)防導(dǎo)管相關(guān)性血流感染課件20預(yù)防導(dǎo)管相關(guān)性血流感染課件21預(yù)防導(dǎo)管相關(guān)性血流感染課件22預(yù)防導(dǎo)管相關(guān)性血流感染課件23預(yù)防導(dǎo)管相關(guān)性血流感染課件24預(yù)防導(dǎo)管相關(guān)性血流感染課件25預(yù)防導(dǎo)管相關(guān)性血流感染課件26預(yù)防導(dǎo)管相關(guān)性血流感染課件27預(yù)防導(dǎo)管相關(guān)性血流感染課件28預(yù)防導(dǎo)管相關(guān)性血流感染課件29預(yù)防導(dǎo)管相關(guān)性血流感染課件30血流感染實(shí)驗(yàn)室診斷方法新進(jìn)展血流感染實(shí)驗(yàn)室診斷方法新進(jìn)展31主要內(nèi)容血流感染的概念血流感染監(jiān)測及流行病學(xué)3)血流感染相關(guān)生物標(biāo)志物實(shí)驗(yàn)室診斷方法新進(jìn)展5結(jié)束語主要內(nèi)容32血流感染泛指是指病原菌及其毒素侵入血流所引起的一類臨床綜合征。病程中常有炎癥介質(zhì)的激活和釋放,引起高熱、寒戰(zhàn)、心動過速呼吸急促、皮疹和神志改變等一系列臨床癥狀,嚴(yán)重者可引起休克、DC和多器官功能衰竭,死亡率較高。敗血癥(septicemia):病原菌及其毒素侵入血流所引起的臨床綜合征,是種嚴(yán)重的全身感染。病原菌主要是細(xì)菌,也可為真菌、分枝杄菌等菌血癥(bacteremia):菌在血流中短暫出現(xiàn)的現(xiàn)象,一般無明顯毒血癥狀,在國外文獻(xiàn)中常與敗血癥通用腴毒血癥(sepsIs):感染+全身性炎癥反應(yīng),血培養(yǎng)可以陽性或陰性血流感弟(bloodstreaminfection,BS):敗血癥和菌血癥目前統(tǒng)稱為血流感染血流感染33醫(yī)院獲得性血流感染原發(fā)性血流感染:實(shí)驗(yàn)室證實(shí)血流感染(Laboratory-confirmedBloodstreamInfection,LCBD)標(biāo)準(zhǔn):從一次或多次血標(biāo)本中培養(yǎng)出一種一致的致病菌,而且培養(yǎng)出的病原體與其它部位的感染無關(guān)臨床血流感染(ClinicalSepsis)標(biāo)準(zhǔn):具有非其它己知原因所引起的發(fā)燒、血壓過低(收縮壓≤90mmHg或收縮壓低于平常超過40mmHg),少尿(每小時(shí)尿量低于30m)等臨床癥狀任何一項(xiàng),且符合下列所有條件者1未做血培養(yǎng),或血培養(yǎng)陰性或血液抗原反應(yīng)呈陰性者2其它部位無明顯感染者醫(yī)生針對此感染中毒癥狀給予適當(dāng)抗菌藥物治療醫(yī)院獲得性血流感染34繼發(fā)性血流感染血培養(yǎng)分離出有意義微生物,而且此微生物與另一部位之院內(nèi)感染有關(guān)。唯不包括血管或血管內(nèi)導(dǎo)管裝置所引起之血流感染?！錾鐓^(qū)獲得性血流感染antbacteria繼發(fā)性血流感染35血流感染監(jiān)測的重要性■為血流感染的流行病學(xué)提供基本信息,監(jiān)測發(fā)生趨勢和發(fā)生率■為新出現(xiàn)的病原菌或耐藥表型提供早期預(yù)警;監(jiān)測罕見菌的檢測為公共衛(wèi)生決策者進(jìn)一步調(diào)查提供幫助■為臨床醫(yī)生提供反饋信息急血流感染監(jiān)測的重要性36血流感染監(jiān)測歷史Table1.KeyeventsinthehistoryofbloodstreaminfectionmonitoringBacteriainthebloodweredescribedforthefirsttimebytheFrenchphysicianCasimir-JosephDavaine,whbservedbacteriainbloodfromanimalswithanthraxThetermbacteremiawascoinedbyEdmeVulpiantoemphasizethepathogenicroleofthenowacceptedphrase"bacteriaintheblood'(forareviewsee179)Around1900BloodculturinghasbecomeanimportantclinicaltoolatmajorhospitalsworldwideAprospectivenationwideStaphyococcusaureusdatabaseisestablishedatStatensSerumInstitut,Copenhagen1953Langmuirformulatesthemodernconceptofsurveillanceinpublichealth,emphasizingtheroleindescribinghealthofpopulationsMartinmadeapleaforanAmericanNationalBacteremiaRegistry(21)9705and1980sThefirstpopulation-basedstudiesofbloodstreaminfectionwereconductedinNorthCarolina[8081McGowanpublishedsurveillancedatafromBostonCityHospital[82]Weinsteinetal.publishedtwoofthemostinfluentialpapersonbloodstreaminfection(19,20)TheintroductionofmicrocomputersallowsmoreefficientdecentralizationofdataanalysisandelectroniclinkageofparticipantsinsurveillancenetworkslefirstprospectivebacteremiaregistriesweredevelopedatSt.Thomas'sHospital,London[83]andatBeilinsonHospitalinPetahTigva,Israel[84]1990sand2000sTheintemetisusedincreasinglytotransmitandreportdataTheEuropeanAntimicrobialResistanceSurveillanceSystem(EARSS,renamedEARS-Netin2010)waslaunchedil血流感染監(jiān)測歷史37血流感染流行病學(xué)特點(diǎn)革蘭氏陽性菌感染呈上升趨勢,特別是凝固酶陰性葡萄球菌、腸球菌■真菌血流感染發(fā)病率逐年上升■革蘭陰性菌感染下降■耐藥菌比例逐年增加廣譜耐藥菌株(VRE、MRSA/MRSE、V|SAVRSA■社區(qū)獲得與醫(yī)院獲得血流感染病原譜存在差異■院內(nèi)BS患者病死率高血流感染流行病學(xué)特點(diǎn)38腫瘤患者血流感染流行病學(xué)趨勢Table1Distnbutionofetiologicagentisolatedfrombacteremiampatientswithcancerinpublishedstudiessinee2008Characteristic/agentfanetal.Cattaneoetal.anderetal.Chongetal.ingetaL,Gudioletal2012[201Studyperiod2001-20062014-20102002-2008200620092006-207,2008-200820062010SwedenSouthkoreaProplylaxisNotreporledNotrepartedNoprophylaxisNoproplylaxisNoprophylaxisNoprophylaxi凸comOrosengi圖m4.7%3.6%Ns17.8%186%netohactersKlebsiella11.6%Ns85%NS3.5%4.7%1.7%NsNNS44%45.5%amlase-ncgntivesaphylococcIyNS83%5.1NS5.8%9.2%Srepsococciasspp55%Ns64%34%epsocbcci.spuelo/me3.5%Ns14%23%EurJClinMicrobiolInfectDis(2013)32:841-850腫瘤患者血流感染流行病學(xué)趨勢39TablAntibioticsusceptibilityamongbuctcramicisolatesinpatientswithcancerinpublishedstudiessince2008antibioticIrfanetaL.20086Killanderetal,Chongetal.ecarichietal.BhusaletalMihuetalStudyperiod2001-20062012-2008206-2009200-20719992008SwedenledstatasedstatesProphylaxisNoprphylaxisNoprophylaxis51.b%recededeaduseofquinoloneWidespreaduseofquinolonequinoloneCeftazidi