Bonten Marc J M
Department of Internal Medicine & Dermatology, Division of Internal Medicine & Infectious Diseases, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
Curr Opin Crit Care. 2004 Oct;10(5):364-8. doi: 10.1097/01.ccx.0000139362.68445.11.
Infections remain an important threat for critically ill patients, and the emergence of antibiotic resistance is increasingly hampering successful treatment. In this review, new aspects of the diagnosis and prevention of ventilator-associated pneumonia and of strategies of antibiotic use to limit the development and spread of resistance are described.
Prevention of ventilator-associated pneumonia is cost effective, but the most optimal preventive measure (or set of measures) remains controversial. There is growing evidence that antibiotic prophylaxis reduces the occurrence of ventilator-associated pneumonia and improves patient outcome. Moreover, antibiotic use can be reduced by increasing the specificity of diagnosing ventilator-associated pneumonia and by limiting the duration of antibiotic treatment.
Recent developments in diagnosis, treatment, and prevention of ventilator-associated pneumonia and strategies to reduce emergence of antibiotic resistance have been reviewed. Whether changes in antibiotic policy will reduce the emergence of antibiotic resistance remains to be determined. In this area, methodologic problems that have been overlooked in many studies have been addressed recently. These issues must be clarified to provide reliable data on the effects of interventions in hospital settings.
感染仍是重症患者面临的重要威胁，抗生素耐药性的出现日益阻碍治疗的成功。本文综述了呼吸机相关性肺炎诊断与预防的新进展以及限制耐药性产生和传播的抗生素使用策略。
预防呼吸机相关性肺炎具有成本效益，但最优化的预防措施（或一系列措施）仍存在争议。越来越多的证据表明，抗生素预防可减少呼吸机相关性肺炎的发生并改善患者预后。此外，通过提高呼吸机相关性肺炎诊断的特异性和限制抗生素治疗疗程可减少抗生素的使用。
本文综述了呼吸机相关性肺炎诊断、治疗和预防方面的最新进展以及减少抗生素耐药性出现的策略。抗生素政策的改变是否会减少抗生素耐药性的出现仍有待确定。在这一领域，许多研究中被忽视的方法学问题最近已得到关注。必须澄清这些问题，以提供关于医院环境中干预措施效果的可靠数据。
