RCW???? ?????

1
RCW?????????

• ???????????????
• ?????
• 2006?2?10?

2
??

• ????HAP (Hospital acquired pneumonia)
• ????48??????????
• ???????VAP (Ventilator associated pneumonia)
• ????72?????????

3
??

• ????????HCAP (Healthcare associated pneumonia)
• ?90????????????
• ????????????
• ??????(???,?????)
• 30??????
• ??????

4
????

• ??????5-10???
• ?????????????6-20?
• ?ICU???25????50??????
• ??VAP?HAP?90
• ??????????VAP?????
• VAP????????33-50

5
???????

• ???VAP
• ??????5?
• ????
• ????????(Pneumococcus, MSSA)
• ???VAP
• ??????5?
• ????
• ????????(Pseudomonas, MRSA)

6
???????

• ????????????
• ????90???????
• ??????5?
• ?????????????????
• ??HCAP???
• ????????????

7
???????

• ????VAP?
• ?????
• ?Sucralfate???????
• ???????
• ???????????
• ?????????

8
RCW????

• ????????
• ????(?50)
• ?????(?15)
• ???(?15)
• ????(?15)

9
RCW????

• ??????
• ????Pseudomonas aeruginosa(?25)
• ????E. coli(?15)
• ???Candida spp.(?10)
• Kp?Klebsiella pneumoniae (?5)
• AB?Acinetobacter baumannii(?5)
• Methicillin??????????MRSA(?5)
• ????????

10
(No Transcript)
11
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12
E. coli
Klebsiella pneumoniae
Pseudomonas aeruginosa
Stenotrophomonas maltophilia
13
Moraxella catarrhalis
Hemophilus influenzae
Acinetobacter baumannii
Burkholderia pseudomallei
14
RCW????

• ??????
• ESBL?????(Extended spectrum Beta lactam),???E.
  coli,Kp
• ???????MDR(Multi-drug resistance),???AB?
• ??????PDR(Pan-drug resistance),???AB?
• MRSA
• VRE(Vancomycin??????)

15
(No Transcript)
16
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17
Clinical Application
18
Clinical Application
19
RCW????

• ESBL?????(Extended spectrum Beta lactam)
• ????????????
• ????Tazocin?Tienam???
• ??????????????????

20
RCW????

• MDR-AB
• ?????????????
• ???Tienam??Amikacin???
• ???????????Sulbactam

21
RCW????

• PDR-AB
• ?????????????
• ????????Sulbactam
• ??????Colimycin

22
RCW????

• MRSA
• ???????????????
• ???Vancomycin?Targocid
• ???????Rifampin

23
RCW????

• VRE
• ??????????
• ???????

24
Thank You for Your Attention

• Special thanks to NTUH Dr.??? for providing
  excellent slides.
• Reference
• Symposium on Infection Control of
  Pandrug-Resistant Superbugs in RC(C)Ws
• Symposium on Management of Ventilator-Associated
  Pneumonia