抗生素与长期护理（英文ppt）antibiotics in long term care课件

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1、AntibioticsinLongTermCareDavidGarySmith,MD,FACPAbingtonMemorialHospitalAudienceResponseSystemKeypads-mustreturnthemRealtimepollingofaudienceAnonymityDoyoureallywanttohearatalkaboutantibioticsandLTC?Yes-andalsodrivenailsintomyfingersNo-IwouldratherlistentoelevatormusicWhatisyourprofession?Nu

2、rseMD/DOSocialWorkAdministratorOtherclinicalGoalsOutlineoftheantibiotic“problem”GuidelinesforantibioticuseaddressoverutilizationAntibioticsandthe“GoalsofCare”dilemmaExistentialmodelforpatientcenterednessatthebedsidePatternsofAntimicrobialUseinNHResidentswithAdvancedDementiaApproximately1yea

3、roff/u66%(n=142)receivedatleastonecourseofantimicrobialtherapy540prescribedcourses42%(n=42)ofdecedentsreceivedantibioticswithintwoweeksoftheirdeathand41courseswereadministeredparenterallyD’AgataE,MithcellS,ArchIntMed2008;168:357-361AntibioticTherapyintheDementedElderlyPopulation:Redefining

4、theEthicalDilemmaLowlikelihoodofbenefitEmergingresistanceAvoidanceof“goalsoftherapy”discussionEasiertotreatthantoraisethe“D”wordCostsSchaberM,CormelliY,ArchIntMed2008;168:349-3502StudiesonBenefitofEducationalProgramonAntibioticUseinLTCFReportedfrequencyofsuboptimalantibioticuse-25-75%Educat

5、ionalinterventionsreducederrorsbyapproximately20%Postinterventionadherencetoprotocolrates-40-77%ScwartzD,et.al.JAGS,2007;.55:1236-1242MonetteJ,et.al.JAGS,2007;55:1231-1235Case88y.o.withindwellingfoleyanddementia.Theclinicalattendantcallsbecausetheurineisdarkandtheculturerevealed>100,000colo

6、niesE.Coli.Shewantstoknowwhatantibioticdoyouwanttouse.Noallergies.Nofever.Whatisyouropinion?TMP/SulfaAmoxacillinLevafloxacinTransferforIVantibioticsNotreatmentMinnesotaGuidelinesNoindwellingcatheterAcutedysuriaorFever>38.9(102F)andatleastoneofthefollowing:UrgencyFrequencySuprapubicpainHemat

7、uriaCVAtendernessNewonseturinaryincontinenceMinnesotaGuidelinesIndwellingFoleyNeedatleastoneofthefollowing:Fever>38.9(102)NewCVAtendernessRigorsNewonsetofdeliriumAnothercallfromsameNH78yopatientwithCOPDandhasnewcoughwithyellowsputum.Tempisnormal.Pulseis8