Critical Care Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
Crit Care Clin. 2011 Jan;27(1):35-51. doi: 10.1016/j.ccc.2010.09.007.
Inappropriate empirical antibiotic therapy for severe infections in the intensive care unit is a modifiable prognostic factor that has a great effect on patient outcome and health care resources. Inappropriate treatment is usually associated with microorganisms resistant to the common antibiotics, which must be empirically targeted when risk factors are present. Previous antibiotic exposure, prolonged length of hospital stay, admission category, local susceptibilities, colonization pressure, and the presence of invasive devices increase the likelihood of infection by resistant pathogens. Consideration of issues beyond in vitro susceptibility, such as antibiotic physicochemistry, tissue penetration, and pharmacokinetic/pharmacodynamic-driven dosing, is mandatory for the optimization of antibiotic use.
在重症监护病房中，针对严重感染使用不适当的经验性抗生素治疗是一个可改变的预后因素，对患者的预后和医疗资源有重大影响。不适当的治疗通常与常见抗生素耐药的微生物有关，当存在危险因素时，必须针对这些微生物进行经验性靶向治疗。先前的抗生素暴露、住院时间延长、入院类别、局部药敏性、定植压力和侵袭性器械的存在增加了感染耐药病原体的可能性。考虑体外药敏性以外的问题，如抗生素的理化特性、组织穿透性和基于药代动力学/药效学的剂量调整，对于优化抗生素的使用是强制性的。
