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Articole Multimedia <strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong>, Iaşi, 2011, Vol. 7, Nr. 3 [ISSN 1584 – 9341<br />
Duration of hypotension prior to effective<br />
antimicrobial therapy:<br />
impact on survival in septic shock<br />
Mortailty (%)<br />
<strong>10</strong>0<br />
80<br />
60<br />
40<br />
20<br />
0<br />
0– 30′–<br />
1–2 2–3 3–4 4–5 5–6 6–9 9–12<br />
12–24<br />
24 24–36<br />
>36<br />
30′ 1h<br />
Time of first dose of antibiotics after<br />
the onset of shock (hours)<br />
Kumar et al. Crit Care Med 2006;34:1589–1596<br />
1596<br />
Impactul antibioterapiei ina<strong>de</strong>cvate<br />
Număr <strong>de</strong> zile după<br />
dg. <strong>de</strong> VAP<br />
30<br />
25<br />
20<br />
15<br />
<strong>10</strong><br />
5<br />
0<br />
Terapie a<strong>de</strong>cvată (n=29)<br />
Terapie ina<strong>de</strong>cvată (n=22)<br />
12<br />
20<br />
durată VM<br />
Dupont H et al. Intensive Care Med. 2001; 27:355-362.<br />
17<br />
29<br />
durata şe<strong>de</strong>rii ATI<br />
VM = ventilaţie mecanică<br />
14<br />
Mortalitate (% pacienţi)<br />
50<br />
40<br />
30<br />
20<br />
<strong>10</strong><br />
0<br />
TERAPIE ADECVATA versus<br />
TERAPIE INADECVATA<br />
29.9<br />
11.9<br />
Ibrahim<br />
(n=492)<br />
Bacteriemie<br />
Terapie ina<strong>de</strong>cvată<br />
24.7<br />
37.0<br />
16.2 15.6<br />
Alvarez-Lerma<br />
(n=430)<br />
Terapie a<strong>de</strong>cvată<br />
Rello (n=113)<br />
33.3<br />
Kollef (VAP,<br />
n=51)<br />
Pneumonie nozocomială/VAP<br />
1. Ibrahim EH, et al. Chest. 2000;118:146-155; 2.Alvarez-Lerma F. Intensive Care Med. 1996;22:387-394. 3. Rello J, et al.<br />
Am J Respir Crit Care Med. 1997;156:196-200.;4. Kollef MH, Ward S. Chest. 1998;113:412-20<br />
15<br />
Terapia antibiotică empirică<br />
Pneumonia Nosocomială ATS/IDSA Gui<strong>de</strong>lines 2005<br />
HAP, VAP, sau HCAP<br />
Factori <strong>de</strong> risc pentru germeni multi rezistenti<br />
(spitalizare, antibiotice in antece<strong>de</strong>nte)<br />
Nu<br />
Da<br />
ATB cu spectru larg<br />
ATB cu spectru limitat<br />
Cfs antipseudomonas (cefepim, ceftazidim)/<br />
Ceftriaxona<br />
Carbapenemi (imipenem, meropenem)/<br />
sau<br />
β-lactam/BLI<br />
Fluoroquinolone gen 3-4<br />
si<br />
(Levo, Moxifloxacina) Fluoroquinolone (levo, moxafloxacin)/aminoglicozi<strong>de</strong><br />
sau<br />
si<br />
Linezolid sau Vancomycin*<br />
Ampicilina/ sulbactam/Ertapenem<br />
Epi<strong>de</strong>miologia HAP/VAP<br />
20<br />
18<br />
18<br />
18 18<br />
17<br />
Evi<strong>de</strong>nţe e clinice în n PN<br />
cu germeni gram<br />
pozitivi<br />
Pneumonia (%)<br />
16<br />
14<br />
12<br />
<strong>10</strong><br />
8<br />
6<br />
4<br />
11<br />
12<br />
7<br />
7<br />
5<br />
4 4 4 4<br />
5<br />
2<br />
0<br />
S aureus P aeruginosa Enterobacter spp Klebsiella<br />
pneumoniae<br />
Candida<br />
albicans<br />
Escherichia coli<br />
Haemophilus<br />
influenzae<br />
*January 1992-May 1999. † 1990-1995.<br />
All HAP* VAP †<br />
NNIS. Am J Infect Control. 1999;27:520-532.<br />
Fridkin SK et al. Infect Dis Clin North Am. 1997;11:479-496.<br />
478
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