GNB infection in hospital -> NEJM 2010-5大整理 -> 使用anti-guidelines

Hospital-Acquired Infections Caused by Gram-Negative Bacteria

A review of a major healthcare challenge

Hospital-acquired infections contribute substantially to rising healthcare costs as well as in-hospital morbidity and mortality. Nosocomial infections caused by gram-negative organisms are a major concern, as these organisms account for more than 30% of hospital-acquired infections and 70% of infections in the intensive care unit.

Gram-negative bacteria have proven particularly adept at developing novel resistance mechanisms, and they employ a variety of resistance strategies. In this review, the authors detail the microbiology, resistance patterns, management strategies, and treatment recommendations for three commonly encountered hospital-acquired infections: pneumonia, bacteremia, and urinary tract infections. In each of these conditions, infections caused by gram-negative organisms, especially pseudomonas, Acinetobacter, and the Enterobacteriaceae family, predominate.

Interventions performed in the hospital, such as mechanical ventilation and insertion of venous and urinary catheters, place patients at risk for developing infections. Rising antibiotic resistance (particularly to extended-spectrum cephalosporins and carbapenems) coupled with severe disease that often is associated with gram-negative infections means that initial management should include broad-spectrum antibiotic coverage (Table 1). For empirical treatment of patients with severe infections, combination therapy ("double coverage") is recommended, with tailoring of antibiotic choice based on local susceptibility data; de-escalation to monotherapy is recommended once susceptibilities are determined. Novel treatment strategies — including continuous infusions of antibiotics, aerosolized antibiotics, and newer antibiotics — might be of benefit, but clinical experience and definitive studies are lacking.

Following evidence-based prevention guidelines is paramount to preventing hospital-acquired infections. Simple activities, such as hand hygiene and sterile techniques, and efforts to minimize patient exposure can lower risk for nosocomial infections (Table 2). Adherence to prevention guidelines is essential if we are to stem the rising tide of hospital-acquired infections.

— Robin Klein, MD

Dr. Klein is an Assistant Professor at Emory University School of Medicine in Atlanta, Georgia.

Published in Journal Watch Hospital Medicine June 7, 2010

Citation(s):

Peleg AY and Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010 May 13; 362:1804.

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• Medline abstract (Free)

裏面有risk factors, 強力用藥指引，相當強大
和目前本院用藥相合
但combination 多很多

有VAP bundle, CVP bundle, UTI bundle

http://docs.google.com/fileview?id=0B278nGJMQBk7MGMzMDIwNzAtNDNhMS00Y2RlLTkxYWEtMGI0ZWY2NGM4YmRk&hl=en