Managing Infections in Hematologic Malignancies Risk-Adjusted Approaches讲座（资料以上传）

Managing Infections in Hematologic Malignancies Risk-Adjusted Approaches

关于血液病恶性肿瘤治疗中感染控制的讲座:)
Target Audience:
This educational activity will be valuable to hematologists and oncologists.
Program Description:
Infections in patients with hematologic malignancies are a major cause of morbidity and mortality. This CME CD-ROM addresses the management of bacterial infections in neutropenic patients and the growing problem of bacterial resistance to drug therapy as exemplified by methicillin-resistant Staphylococcus aureus (MRSA) in seriously ill patients.It also reviews our current understanding of invasive fungal infections and closes with a discussion of the use of combination antifungal therapy: premature or ready for prime time.
感染是血液肿瘤疾病中重要的发病率和死亡率的原因.这个讲座强调在中性粒细胞减少病人中对细菌感染的控制,和日益增长的细菌耐药问题中药物治疗问题,以重症患者的MRSA治疗举例说明.同时对我们当前的侵入性真菌感染做了次总结和抗真菌治疗联合用药进行讨论: premature or ready for prime time.

讲座内容:
Welcome and Introduction
John R. Wingard, MD, Chair

Price Eminent Scholar and Professor of Medicine
Director, Blood and Marrow Transplant Program
Associate Director, Clinical & Translational Research
University of Florida Shands Cancer Center
Division of Hematology/Oncology
University of Florida College of Medicine
Gainesville, Florida

What’s New in the Management of Bacterial Infections in the Neutropenic Patient?
中性粒细胞减少患者中细菌感染控制进展
Kenneth V. Rolston, MD

Professor of Medicine
Department of Infectious Diseases, Infection Control, and Employee Health
The University of Texas
MD Anderson Cancer Center
Houston, Texas

Rising Threat of MRSA in the Seriously Ill Patient
重症患者MRSA治疗风险
Pranatharthi H. Chandrasekar, MD

Professor, Department of Internal Medicine
Program Director, Infectious Diseases Fellowship
Wayne State University School of Medicine
Detroit, Michigan

Invasive Fungal Infections in High-Risk Patients: What Have We Learned So Far?
高风险患者的侵入性真菌感染
John R. Wingard, MD

Combination Antifungal Therapy: Timely or Premature?
The Pro Viewpoint

联合抗真菌治疗:及时的还是早点预防?
William J. Steinbach, MD

Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases
Duke University Medical School
Durham, North Carolina

The Con Viewpoint
John R. Graybill, MD

Professor, Department of Medicine
University of Texas Health Science Center
San Antonio, Texas

Rebuttals and Conclusion
William J. Steinbach, MD
John R. Graybill, MD
John R. Wingard, MD























































在讲座完后有题目做:)希望大家都来参与下,看了几位白发苍苍的教授讲完课后,真觉得人家真的是在做学问呀:)

CME Post-Test
1) The most frequently isolated gram-positive pathogen in neutropenia is
A. Coagulase-negative staphylococci
B. Staphylococcus aureus
C. Enterococcus spp.
D. Listeria monocytogenes

1）在中性粒细胞减少患者中最常见的革兰氏阳性菌是：
A.凝固酶阴性葡萄球菌
B.金黄色葡萄球菌
C.肠球菌
D.单核细胞增生性李斯特氏菌

2) Approximately what percent of documented bacterial infections are polymicrobial?
A. 5%
B. 15%
C. 30%
D. 50%

2)有大概多少的报道细菌感染中为多重细菌感染?
A. 5%
B. 15%
C. 30%
D. 50%

3) Which of the following clinical criteria is not used to identify low-risk patients?
A. Inpatient at onset of febrile episode
B. Solid tumor, conventional chemotherapy
C. Hemodynamic stability/minimal comorbidity
D. Expected duration of neutropenia ≤7 days

3)下面哪一个标准没有用于确定低风险患者?
A.在发热初始即住院的患者
B.实体瘤,常规化疗的患者
C.血液动力学稳定者或共患病极少者
D.中性粒细胞减少期间少于7天的患者

4) The nosocomial bloodstream infection resistance rate is highest for ___________.
A. Methicillin-resistant coagulase-negative staphylococci
B. Methicillin-resistant Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Vancomycin resistant enterococci

4)医院内血行感染的耐药率如此高是由于:
A.MRCNS耐甲氧西林凝固酶阴性葡萄球菌
B.MRSA耐甲氧西林金黄色葡萄球菌
C.绿脓杆菌/铜绿假单胞菌
D.VRE抗万古霉素肠球菌

5) The antibiotic with the lowest prevalence of co-resistance is ____________.
A. Ciprofloxacin
B. Trimethoprim-sulfamethoxazole
C. Gentamicin
D. Erythromycin

5)共同抗药性发生率最低的抗生素是:
A.环丙沙星
B.甲氧苄氨嘧啶-磺胺甲基异恶唑/复方磺胺甲噁唑
C.庆大霉素
D.红霉素

6) Common sites of community-acquired S aureus infections are
A. Bones and joints and prostheses
B. Endocarditis and skin and soft tissue
C. Superficial wounds and soft tissue
D. Surgical wounds and vascular catheters

6)常见的社区获得性金黄色葡萄球菌的部位是:
A.骨,关节和假体
B.心内膜炎和皮肤,还有软组织
C.表面创伤和软组织
D.手术伤口和血管导管

7) Problems associated with vancomycin include
A. Numerous treatment failures
B. Oral form raises resistance level
C. Poor killing activity
D. All of the above

7)万古霉素使用的问题包括
A.治疗失败无数
B.口服形式增加耐药水平
C.杀菌活性低下
D.以上均是

8) Which species of Candida is associated with fluconazole resistance rates of 80%-91%?
A. C albicans
B. C glabrata
C. C krusei
D. C parapsilosis

8）下面哪种菌在氟康唑使用中耐药率为80％～91％？
A.白念珠菌
B.光滑念珠菌
C.克柔念珠菌/克鲁丝假丝酵母
D.平滑假丝酵母

9) The galactomannan assay is recommended for which of the following patients?
A. Adults with neutropenia/and or BMT
B. Children
C. Solid-organ transplant recipients
D. Suspected cases of aspergillosis

9）在下面哪种患者半乳甘露聚糖的检测是推荐的
A.中性粒细胞减少的成人患者和或骨髓移植患者
B.儿童
C.实体器官移植受者
D.可疑曲霉菌感染着

10) Current therapy for invasive Candida and Aspergillus infections is best directed by _______________.
A. Anecdotal reports
B. Clinical experience
C. Historical studies
D. Randomized trials

10）目前对侵入性念珠菌和曲霉菌感染的治疗最好是以什么为指导？
A.轶闻病例报道
B.临床经验
C.回顾性分析
D.随机实验

11) Which of the following is NOT considered a rationale for combination therapy?
A. Widened spectrum of potency
B. Additive or synergistic efficacy effects
C. Lowered dosing or less toxicity
D. All of the above are considered rationales for combination therapy

11）下面哪种情况不考虑联合治疗？
A.广谱抗菌药使用
B.具有协同抗菌效果
C.所需剂量低或毒性低
D.以上均可考虑联合抗菌治疗

12) The MITT portion of the study comparing voriconazole to amphotericin B found that
A. Amphotericin B was more successful in treating aspergillosis than voriconazole
B. Voriconazole was more successful in treating aspergillosis than amphotericin B
C. Amphotericin B and voriconazole were equal in terms of successful treatment of aspergillosis
D. Neither treatment was successful in treating aspergillosis

12）

13) The only clinical trial of combination antifungal therapy for aspergillosis
A. Compared amphotericin B to amphotericin B + 5 flucytosine
B. Assessed neutropenic adult patients with proven invasive fungal infection
C. Found that mortality was significantly lower in the combination therapy group
D. A and B only

14) According to Becker et al, which of the following experimental combination therapies shows significant increase in survival over monotherapy, decrease in lung chitin content, and difference in galactomannan?
A. Voriconazole + caspofungin
B. Ravuconazole + micafungin
C. Liposomal amphotericin B + amphotericin B
D. Caspofungin + liposomal amphotericin B

15) The study that assessed combination therapy of amphotericin B + fluconazole vs fluconazole monotherapy for treatment of Candida patients found that
A. The combination therapy arms were more successful in treating patients
B. Success was not related to pre-exposure to fluconazole
C. A stepwise logistic regression found that odds of failure decreased by using monotherapy
D. A and C are correct

16) According to experimental combination therapies used for the treatment of Candida, which of the following is correct?
A. Survival and fungal burden efficacy are significantly higher in the combination therapy amphotericin B + fluconazole group versus monotherapy
B. Fluconazole + cyclosporine was the only combination that significantly reduced fungal vegetation densities
C. Fluconazole + cyclosporine is similar to both amphotericin B or fluconazole in sterilizing the kidneys
D. Caspofungin + fluconazole was not superior to fluconazole alone

17) The rationales presented against using combined fluconazole and amphotericin B to treat candidemia included
A. Difficulty identifying the small group of patients who would benefit most from this combined therapy
B. Amphotericin B was found to be nephrotoxic in combination with fluconazole
C. The cost of substituting liposomal amphotericin B may not be worthwhile because there is no difference in mortality between the 2 study arms
D. All the rationales are used as reasons not to use fluconazole and amphotericin B in combination to treat candidemia

18) Arguments against the use of combination antifungal therapy at this time include all EXCEPT
A. Anecdotes are not sufficient proof of effectiveness of combination therapy
B. Animal and clinical trials differ in their characteristics making it difficult to compare
results
C. Use of combination therapy is premature
D. Drug doses are rarely reduced for oncology patients despite toxicity

19) Recommendations for developing a solid database for combination therapy for aspergillosis include
A. Define attributable mortality simply
B. Use the MSG/EORTC definitions of probable and documented infections
C. Undertake prospective randomized clinical trials
D. All of the above
大家先看讲座,再做题,光盘上没有答案,我想办法看看,大家先做一下,如果E文不好,我晚上把题目翻译下,希望大家多看看,开卷有益:)

下载的地址我已传到儿科FTP上了,在儿科区内，多谢搬运工战友转移:

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大家边听讲座边做题,把答案写在下面,希望大家积极参与:)