Rice Louis B
Louis Stokes Cleveland VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Cleve Clin J Med. 2007 Aug;74 Suppl 4:S12-20. doi: 10.3949/ccjm.74.suppl_4.s12.
Accumulating evidence indicates that treating seriously ill infected patients with active antibiotics early in the course of infection is critical to improving outcomes. The most common reason for ineffective empiric therapy is resistance to the agents used. Gram-negative bacteria are becoming increasingly resistant to many commonly used antibiotics, and some cases require older, more toxic antibiotics for adequate microbial coverage. The diversity of resistance mechanisms that underly multidrug resistance makes developing effective new antimicrobial agents very difficult, especially against problematic species such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. This growing problem requires a multipronged strategy that includes adherence to infection control principles, parsimonious and rational use of current antimicrobial agents, and development of new agents active against multidrug-resistant pathogens.
越来越多的证据表明，在感染过程早期用有效的抗生素治疗重症感染患者对于改善预后至关重要。经验性治疗无效的最常见原因是对所用药物耐药。革兰氏阴性菌对许多常用抗生素的耐药性日益增强，有些病例需要使用更古老、毒性更大的抗生素才能实现足够的微生物覆盖。导致多重耐药的耐药机制多种多样，这使得开发有效的新型抗菌药物非常困难，尤其是针对鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌等棘手菌种。这个日益严重的问题需要采取多管齐下的策略，包括坚持感染控制原则、节约合理使用现有抗菌药物，以及开发针对多重耐药病原体的新型药物。
