Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Université de la Méditerranée, Chemin des Bourrely, 13915 Marseille Cedex 20, France.
Expert Opin Emerg Drugs. 2010 Mar;15(1):41-52. doi: 10.1517/14728210903559860.
Sepsis remains a major cause of death in intensive care units. Despite an intense research, a new drug that is effective in reducing mortality in sepsis is still awaited.
The literature was analyzed with Pubmed() during the 2008 - 2009 period. If required, seminal articles published before 2008 were cited. Clinical trials focusing on 'sepsis' were first assessed. Next, relevant experimental data in this field were reported.
The goal of the review is to determine the role for new licensed antibiotics, to give an insight into the conflict on adjuvant therapies and to disclose new experimental concepts.
New licensed antibiotics will offer the opportunity to refine the treatment choices. Direct hemoperfusion using polymyxin B-immobilized fiber column may be an option in sepsis due to Gram-negative bacilli. Among non-antibiotic drugs, new ongoing studies will clarify the role of drotrecogin alfa (activated) and low dose hydrocortisone. The modulation of monocytic human leukocyte antigen-DR seems the most prominent treatment. The use of cardiovascular drugs requires well-conducted clinical trials. The regulation of high mobility group box 1, adenosine blockade or correction of the impaired energy production is still at the experimental level.
败血症仍然是重症监护病房死亡的主要原因。尽管进行了大量的研究，但仍在等待一种能有效降低败血症死亡率的新药。
这篇综述分析了 2008 年至 2009 年期间 Pubmed()上的文献。如果需要，还引用了 2008 年之前发表的重要文章。首先评估了以“败血症”为重点的临床试验。接下来，报告了该领域的相关实验数据。
综述的目的是确定新批准的抗生素的作用，深入了解辅助治疗的冲突，并揭示新的实验概念。
新批准的抗生素将有机会改进治疗选择。由于革兰氏阴性杆菌，使用聚明胶纤维柱固定多粘菌素 B 的直接血液灌流可能是败血症的一种选择。在非抗生素药物中，正在进行的新研究将阐明活化的重组人凝血因子 VII 和低剂量氢化可的松的作用。单核细胞人白细胞抗原-DR 的调节似乎是最突出的治疗方法。心血管药物的使用需要进行精心设计的临床试验。高迁移率族蛋白 1 的调节、腺苷阻断或纠正受损的能量产生仍处于实验阶段。
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