147.3 🩺 內科專科考前版

147.3.0.1 1⃣ 22E 曎新

  • Universal decolonization in ICU: chlorhexidine bath + nasal mupirocin (REDUCE-MRSA trial 2013) — adopted widely
  • MRSA prevention bundle complete
  • Antibiotic-impregnated catheters (chlorhexidine, silver, minocycline) — variable evidence
  • CHG bath for all ICU patients ↓ CLABSI 鎂 +blood stream
  • Procalcitonin to guide antibiotic duration in VAP
  • 2024 SHEA/IDSA Compendium: comprehensive HAI prevention

147.3.0.2 2⃣ MDR (Multidrug-Resistant Organisms)

147.3.0.2.1 重芁 MDR
MDR 治療遞擇
MRSA Vancomycin / Linezolid / Daptomycin / Ceftaroline / Tedizolid / Telavancin
VRE Linezolid / Daptomycin (high-dose) / Tigecycline
ESBL Carbapenem (preferred over pip-tazo per MERINO)
CRE Ceftazidime-avibactam, Meropenem-vaborbactam, Imipenem-relebactam, Cefiderocol, Plazomicin, Eravacycline
MDR Pseudomonas Ceftolozane-tazobactam, Ceftazidime-avibactam, Imipenem-relebactam, Cefiderocol
MDR Acinetobacter Sulbactam-durlobactam (2023 FDA), Cefiderocol, Polymyxins, Tigecycline
Stenotrophomonas TMP-SMX, Levofloxacin, Tigecycline, Minocycline, Cefiderocol

147.3.0.3 3⃣ 台灣 context

  • Stewardship programs (CDC + NHRI)
  • CRE surveillance — KPC / NDM / OXA-48 / IMP / VIM 郜有
  • Hand hygiene compliance monitored
  • VAP bundle, CLABSI bundle adopted in major hospitals
  • 健保 anti-CRE / anti-MDR (CAZ-AVI, ceftolozane-tazo, cefiderocol, polymyxin) restricted — ID consult required