抗生素治疗严重细菌感染

IF 21.2 1区 医学 Q1 CRITICAL CARE MEDICINE
Jean-François Timsit, Lowell Ling, Etienne de Montmollin, Hendrik Bracht, Andrew Conway-Morris, Liesbet De Bus, Marco Falcone, Patrick N. A. Harris, Flavia R. Machado, José-Artur Paiva, David L. Paterson, Garyphallia Poulakou, Jason A. Roberts, Claire Roger, Andrew F. Shorr, Alexis Tabah, Jeffrey Lipman
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引用次数: 0

摘要

背景:对严重感染患者进行抗生素治疗对于改善预后至关重要。相反,对易感病原体使用过广泛的抗生素治疗或对无细菌感染的患者使用不必要的抗生素,与危及生命的不良事件和重复感染有关。抗生素引起的人类微生物群的变化改变了免疫和代谢系统。不加控制地使用抗生素会促进耐抗生素生物的出现。在接受抗生素治疗的ICU患者中,约有50%没有确诊感染,而降低抗生素剂量和缩短治疗时间的情况并不常见。严重感染的死亡率仍然很高,这突出了优化治疗的必要性。MethodsNarrative审查。目的总结优化严重感染抗生素治疗的现有证据、新出现的方案和未解决的争议。结果当地流行病学、基础疾病、卫生保健系统的可及性和诊疗资源是考虑的重要因素。快速诊断测试结合个性化决策改进了抗生素治疗的选择。快速降级为窄谱单药治疗和缩短治疗时间应成为规则。对于难以治疗的耐药细菌的个性化治疗仍然存在不确定性。药代动力学(PK)优化和长期或连续使用β -内酰胺是安全的,并可能改善结果。应使用治疗性药物监测(TDM),特别是当怀疑分布量改变和/或药物清除或可能存在毒性时。TDM结合及时调整剂量的影响是鼓励的。包括快速广泛诊断测试和电子抗生素优化工具在内的新兴技术将进一步支持药剂师、微生物学家、传染病专家和重症医师之间的合作,以优化抗生素治疗并管理这些宝贵的资源。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antibiotic therapy for severe bacterial infections

Background

Early antibiotic therapy for patients with severe infections is essential to improve outcomes. Conversely, use of overly broad antibiotic therapy for susceptible pathogens or unnecessary antibiotics in patients without bacterial infections is associated with adverse life-threatening events and superinfections. Antibiotics-induced changes in the human microbiota alter both immune and metabolic systems. Uncontrolled antibiotic use encourages emergence of antibiotic-resistant organisms. Around 50% of ICU patients receiving antibiotic therapy do not have confirmed infections, whilst de-escalation and shortened treatment duration are infrequently performed. Mortality from serious infections remains high, highlighting the need for treatment optimisation.

Methods

Narrative review.

Objectives

To summarise the available evidence, emerging options, and unresolved controversies in optimising antibiotic therapy in severe infections.

Results

Local epidemiology, underlying illnesses, accessibility to health care systems, and diagnostic and therapeutic resources are important factors to consider. Rapid diagnostic tests combined with individualised decision-making improve the selection of antibiotic therapy. Rapid de-escalation to narrow-spectrum monotherapy and shortening of the duration of therapy should be the rule. Uncertainty still persists regarding the personalisation of therapy for difficult-to-treat resistant bacteria. Pharmacokinetic (PK) optimisation and prolonged or continuous beta-lactam use is safe and may improve outcomes. Therapeutic drug monitoring (TDM) should be used, especially when altered volume of distribution and/or drug clearance is suspected or where toxicity is likely. The impact of TDM combined with prompt dose adjustment is encouraged. Emerging technologies including rapid broad diagnostic tests and electronic antibiotic optimisation tools will further support collaboration between pharmacists, microbiologists, infectious diseases specialists, and intensivists for optimising antibiotic therapy and stewarding these precious resources.

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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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