Corona Alberto, Bertolini Guido, Ricotta Anna Maria, Wilson A Peter R, Singer Mervyn
GiViTI Coordinating Centre, Istituto di Ricerche Farmacologiche Mario Negri, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, Ranica (BG), Italy.
J Antimicrob Chemother. 2003 Nov;52(5):849-52. doi: 10.1093/jac/dkg447. Epub 2003 Sep 30.
No definitive evidence is available to inform 'best' antibiotic practice for treating bacteraemia in the critically ill patient, either in terms of duration of therapy, or the use of mono- versus combination therapy. We therefore undertook a large-scale international survey to assess the variability of current practice.
A questionnaire was sent to membership lists of national and international intensive care societies.
Responses from 254 intensive care units in 34 countries revealed a wide variation in antibiotic strategy for all types of bacteraemia, ranging from short course (<or=5 days) therapy with restricted-spectrum antibiotics, to long course (>or=10 days) use of broad-spectrum combinations. Two factors were significantly associated with antibiotic prescribing practice, namely the country of origin (in those with >or=10 responders) and the level of microbiologist and/or infectious diseases specialist input. The greater the specialist input, the shorter the duration of therapy (P < 0.0001).
The wide variability in antibiotic prescribing patterns suggests an urgent need to produce high-quality evidence to identify optimal antibiotic prescribing policies for bacteraemia in the critically ill patient.
无论是在治疗疗程方面，还是在单药治疗与联合治疗的使用方面，均没有确凿的证据可用于指导危重症患者菌血症的“最佳”抗生素治疗方案。因此，我们开展了一项大规模的国际调查，以评估当前治疗方案的差异。
向国内和国际重症监护学会的成员名单发送了调查问卷。
来自34个国家的254个重症监护病房的回复显示，对于所有类型的菌血症，抗生素治疗策略存在很大差异，从使用窄谱抗生素的短疗程（≤5天）治疗，到使用广谱联合抗生素的长疗程（≥10天）治疗。有两个因素与抗生素处方实践显著相关，即来源国（回复者≥10人的国家）以及微生物学家和/或传染病专家的参与程度。专家参与程度越高，治疗疗程越短（P<0.0001）。
抗生素处方模式的广泛差异表明，迫切需要提供高质量的证据，以确定危重症患者菌血症的最佳抗生素处方策略。
