127.3 🩺 內科專科考前版

127.3.0.1 1️⃣ Surviving Sepsis Campaign 2021 — 重點

• 1-hr bundle 上述
• Crystalloid > Albumin (no benefit)
• Norepinephrine = first-line vasopressor (NE > Dopa)
• Vasopressin as second pressor (add at NE 0.25-0.5 μg/kg/min)
• Hydrocortisone 200 mg/day in refractory shock (NE > 0.25)
• Glucose target 180: avoid < 110 or > 180

127.3.0.2 2️⃣ Antibiotic De-escalation

• 48-72 hr 後依培養 narrow spectrum
• PCT trend 下降 → consider de-escalation
• 一般 7-10 days for most bacterial infections (有 trend 縮短至 5-7 d for stable)

127.3.0.3 3️⃣ 22E 更新

• Cefiderocol (FDA 2019): siderophore cephalosporin, 對 CRE / MDR Pseudomonas / Acinetobacter
• Ceftolozane-tazobactam, Imipenem-relebactam, Meropenem-vaborbactam: anti-CRE
• Sulbactam-durlobactam (2023 FDA): for Acinetobacter baumannii
• Tedizolid, omadacycline, lefamulin: 新一代 oxazolidinone, tetracycline, pleuromutilin

127.3.0.4 4️⃣ 台灣 context

• NHRI surveillance: CRE, VRE, MRSA 國家監測
• DOH-MOHW antibiotic stewardship 政策
• 健保 restricted antibiotics: vancomycin, daptomycin, linezolid, polymyxin, carbapenems, tigecycline → 需 ID consult

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