重症成年患者的抗生素耐药性感染

Antibiotic-resistant infections in the critically ill adult.

作者信息

Silveira Fernanda, Fujitani Shigeki, Paterson David L

机构信息

Division of Infectious Diseases, University of Pittsburgh Medical Center, Suite 3A, Falk Medical Building, 3601 5th Avenue, Pittsburgh, PA 15213, USA.

出版信息

Clin Lab Med. 2004 Jun;24(2):329-41. doi: 10.1016/j.cll.2004.03.002.

DOI:10.1016/j.cll.2004.03.002

PMID:15177843

Abstract

Intensive care units (ICUs) frequently are the epicenter of nosocomial infections with antibiotic-resistant bacteria. Optimization of antibiotic therapy for seriously ill patients with bacterial infections appears to have a strong influence on outcome. Laboratories can aid in provision of appropriate antibiotic therapy by providing clinicians with "antibiograms" to aid empiric antibiotic choice and by providing minimal inhibitory concentrations of key antibiotics so that antibiotic dosing is optimized to key pharmacodynamic targets. Laboratories also play a crucial role in the prevention of antibiotic resistance in the ICU. Molecular epidemiologic evidence of an oligoclonal outbreak of infections orients prevention measures toward investigation of common environmental sources of infection and prevention of patient-to-patient transmission. In contrast, evidence of polyclonality shifts prevention of antibiotic resistance to antibiotic management strategies.

摘要

重症监护病房（ICU）常常是耐抗生素细菌医院感染的中心。对患有细菌感染的重症患者进行抗生素治疗的优化似乎对治疗结果有很大影响。实验室可以通过为临床医生提供“抗菌谱”以辅助经验性抗生素选择，并提供关键抗生素的最低抑菌浓度，从而使抗生素剂量根据关键药效学靶点进行优化，以此协助提供适当的抗生素治疗。实验室在预防ICU中的抗生素耐药性方面也发挥着关键作用。感染寡克隆暴发的分子流行病学证据将预防措施导向对常见环境感染源的调查以及患者之间传播的预防。相比之下，多克隆性证据则将抗生素耐药性的预防转向抗生素管理策略。