Alvarez-Lerma F, Palomar M, Grau S
Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain.
Drugs. 2001;61(6):763-75. doi: 10.2165/00003495-200161060-00005.
Indications for the use of antimicrobials in critically ill patients are similar to those for other hospitalised patients. However, the selection of agents depends on the particular characteristics of patients in the intensive care unit (ICU), the form of presentation of infection, the type of infection and the bacteriological features of the causative pathogens. The use of antimicrobials in patients admitted to medical-surgical ICUs varies between 33 and 53%. The selection of empirical antimicrobials to be included in treatment protocols of the most common infections depends on the strong interrelationship between patient characteristics, predominant pathogens in each focus. and antimicrobials used for treatment. Epidemiological studies carried out in the past have identified the microorganisms most frequently responsible for community-acquired and nosocomial infections in patients admitted to ICUs. Susceptibility to antimicrobial agents may be different between each geographical area, between each hospital and even within the same hospital service. In addition, susceptibility patterns may change temporarily in relation to the use of particular antimicrobials or in association with other unknown factors so that assessment of endemic antimicrobial resistance patterns is very useful in order to tailor the antimicrobial regimens of therapeutic protocols. Antimicrobial use should not be a routine procedure. The clinical course of the patient (an indicator of effectiveness) should be closely monitored as well as the possible appearance of adverse effects and/or multiresistant pathogens. Controls are based on the assessment of plasma drug concentrations and microbiological surveillance to detect the presence of multiresistant strains or new antibacterial-resistant pathogens. Prevention of the development of multiresistant pathogens is the main goal of the ICU antimicrobial policy. Although a series of general strategies to reduce the presence of multiresistant pathogens have been proposed, the implementation of these recommendations in ICUs requires the cooperation of a member of the intensive care team.
重症患者使用抗菌药物的指征与其他住院患者相似。然而，药物的选择取决于重症监护病房（ICU）患者的特定特征、感染的表现形式、感染类型以及致病病原体的细菌学特征。入住内科 - 外科ICU的患者抗菌药物使用率在33%至53%之间。在最常见感染的治疗方案中选择经验性抗菌药物取决于患者特征、每个感染部位的主要病原体以及用于治疗的抗菌药物之间的紧密相互关系。过去进行的流行病学研究已经确定了ICU患者中社区获得性感染和医院感染最常见的微生物。不同地理区域、不同医院甚至同一医院科室之间对抗菌药物的敏感性可能不同。此外，敏感性模式可能会因特定抗菌药物的使用或与其他未知因素相关而暂时改变，因此评估地方性抗菌药物耐药模式对于制定治疗方案的抗菌药物治疗方案非常有用。抗菌药物的使用不应是常规程序。应密切监测患者的临床病程（有效性指标）以及不良反应和/或多重耐药病原体的可能出现。控制措施基于血浆药物浓度评估和微生物监测，以检测多重耐药菌株或新的抗菌药物耐药病原体的存在。预防多重耐药病原体的出现是ICU抗菌药物政策的主要目标。虽然已经提出了一系列减少多重耐药病原体存在的一般策略，但在ICU中实施这些建议需要重症监护团队成员的合作。
