1、 1医院内重度肺部感染抗感染治疗策略2医院内肺炎我国最常见的医院感染类型332003年上海市57708例次医院感染构成情况163219.98.70.9 1.7 0.44.30.6 0.6 1 1.3 0.2 0.1 0 0.23.58.505101520253035上感下感泌尿腹泻抗泻腹内腹水表切深切腔隙导管菌血脑膜颅脓椎管烧伤皮肤其它4我国呼吸机相关肺炎VAP远高于NNIS监测结果ICU类型感染率2005年 2006年CCU 20.55 20.82 心胸ICU 17.77 14.84 内科ICU 28.86 32.41 混合ICU 24.74 25.34神经外科ICU 24.05 25.11
2、儿科ICU 15.53 13.05 外科ICU 25.34 24.72 创伤ICU 40.32 27.51呼吸ICU 19.01 27.08 55医院内肺炎的“三高”与“三难”三高发病率高病死率高医疗花费高三难诊断困难治疗困难预防困难6HAP的良好处置，有赖于 准确的诊断 合适的抗菌治疗 延误或错误的抗菌治疗增加死亡 适宜的预防措施Guideline：A bundle strategy approach aims to maximize patient benefit by identifying a small number of simple, effective and robust k
3、ey core care elements, with a view to targeting these for universal adoption.7HAP GuidelinesName Year Method Scope Country Treatment Prevention DiagnosisBSAC 2006 SR HAP UK ATS 2005 SR HAP USA GALANN 2005 EO HAP Lat/Am CCCS 2004 SR VAP Canada HICPAC 2004 SR HAP USA GEIH etc.2004 EO VAP Spain (severe
4、)Corona 2004 EO VAP Italy Collard 2003 SR VAP USA ICCC 2002 EO VAP Global Rello 2001 EO VAP Spain ERS 2001 EO VAP Europe SR = systematic review EO = expert opinion8欧洲医院内肺炎指南发 情况Journal of Antimicrobial Chemotherapy Advance Access published May 31, 2007Country Year Scope Method 诊断 治疗 预防Germany 2003 H
5、AP/VAP CO/SR X X XFrance 2004 HAP/VAP/HCAP CO X X XSpain 2004 HAP/VAP CO X XUK 2006 HAP/VAP/HCAP SR X X XNetherlands2006 VAP CO XGreece 2006 HAP/VAP/HCAP CO/SR X X XTurkey 2002 HAP/VAP CO X X XDenmark 2006 HAP/VAP/HCAP CO X X XBelgium 2002 HAP/VAP CO X XSweden 2006 HAP/VAP CO XSR systematic review；CO consensus opinion99重症医院内肺炎病原体复杂，病死率高10 菌， 菌 肺炎 菌 菌 菌， 菌 MRSA 菌的VAP currency1“院内fi fl菌或病 的HAP VAP HAP、VAP和HCAP的常见病原菌
