优化医院感染的早期诊断与治疗全球约12%－27%（英国）的ICU患者是因严重脓毒血症入院更多患者在ICU中获得严重脓毒血症（特别是复合外伤患者）抗生素研发面临停滞聪明的细菌有个魔球（杂交性、获取遗传物质）高效的广谱抗生素的广泛应用导致细菌耐药性增加我们必须谨慎而合理地使用抗生素！初始治疗正确敏感性的地区差异降阶梯治疗抗生素治疗疗程总结及要点Garnacho-MonteroJ,Garcia-GarmendiaJL,Barrero-AlmodovarA,Jimenez-JimenezFJ,Perez-ParedesC,Ortiz-LeybaC.Impactofadequateantibiotictherapyontheoutcomeofpatientsadmittedtotheintensivecareunitwithsepsis.CritCareMed2003;31:2742-2751.KollefMH,ShermanG,WardS,FraserVJ.Inadequateantimicrobialtreatmentofinfections:ariskfactorforhospitalmortalityamongcriticallyillpatients.Chest1999;115:462-474.RelloJ,GallegoM,MariscalD,SonoraR,VallesJ.Thevalueofroutinemicrobialinvestigationinventilator-associatedpneumonia.AmJRespirCritCareMed1997;156:196-200.IreguiM,WardS,ShermanG,FraserVJ,KollefMH.Clinicalimportanceofdelaysintheinitiationofappropriateantibiotictreatmentforventilator-associatedpneumonia.Chest2002;122:262-268.LunaCM,VujacichP,NiedermanMS,VayC,GherardiC,MateraJ,JollyEC.ImpactofBALdataonthetherapyandoutcomeofventilator-associatedpneumonia.Chest1997;111:676-685.LeiboviciL,DruckerM,KonigsbergerHetal.Septicshockinbacteremicpatients:riskfactors,featuresandprognosis.ScandJInfectDis1997;29:71-75.VallesJ,RelloJ,OchagaviaA,GarnachoJ,AlcalaMA.Community-acquiredbloodstreaminfectionincriticallyilladultpatients:impactofshockandinappropriateantibiotictherapyonsurvival.Chest2003;123:1615-1624.IbrahimEH,ShermanG,WardS,FraserVJ,KollefMH.TheinfluenceofinadequateantimicrobialtreatmentofbloodstreaminfectionsonpatientoutcomesintheICUsetting.Chest2000;118:146-155.Alvarez-LermaF.Modificationofempiricantibiotictreatmentinpatientswithpneumoniaacquiredintheintensivecareunit.ICU-AcquiredPneumoniaStudyGroup.IntensiveCareMed1996;22:387-394.MacArthurRD,MillerM,AlbertsonTetal.Adequacyofearlyempiricantibiotictreatmentandsurvivalinseveresepsis:ExperiencefromtheMONARCSTrial.ClinInfectDis2003;38:284-288.HarbarthS,GarbinoJ,PuginJetal.Inappropriateinitialantimicrobialtherapyanditseffectonsurvivalinaclinicaltrialofimmunomodulatingth