Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD.
Crit Care Resusc. 2010 Sep;12(3):162-70.
To evaluate antibiotic prescribing practices in empirical and directed treatment of severe sepsis and septic shock in Australian and New Zealand intensive care units.
DESIGN, SETTING AND PARTICIPANTS: Case vignette survey of intended antibiotic prescribing for ICU patients with sepsis associated with community-acquired pneumonia (CAP), intra-abdominal infection (IAI), hospital-acquired pneumonia (HAP) or an unidentified infectious cause (UIC). Eighty-four specialists and advanced trainees working in an ICU setting in Australia and New Zealand responded to a questionnaire survey conducted between February and May 2009.
Empirical and directed antibiotic therapy, including mode of administration, frequency of administration, dose and duration of therapy.
A total of 656 antibiotics were empirically "prescribed", including 25 unique antibiotics. Combination therapy was prescribed in 82% of cases, with dual cover for CAP and triple therapy for IAI most common. Directed single-agent cover for Pseudomonas aeruginosa in HAP and flucloxacillin monotherapy for methicillin-sensitive Staphylococcus aureus bacteraemia were prescribed in 65% and 51% of cases, respectively. Supportive gentamicin therapy was commonly recommended (32% of all cases), predominantly in the form of once-daily dosing. Daily gentamicin dosage varied from 3 to 7mg/kg (excluding one outlier), and was largely compliant with recommendations (76% of doses being ≥5 mg/kg). Main areas of noncompliance with guidelines were provision of broader cover for resistant organisms and Β-lactam underdosing. Continuous and extended infusions were uncommon (5%).
Antibiotic prescribing was largely appropriate, but consideration of site-specific resistance profiles and avoidance of low dosing is advocated to provide appropriate upfront cover, prevent underdosing and reduce the risk of developing resistant organisms.
评估澳大利亚和新西兰重症监护病房严重脓毒症和感染性休克经验性和靶向治疗中抗生素的使用情况。
设计、地点和参与者：对澳大利亚和新西兰重症监护病房中与社区获得性肺炎（CAP）、腹腔内感染（IAI）、医院获得性肺炎（HAP）或不明原因感染（UIC）相关的脓毒症患者的预期抗生素使用情况进行病例情节调查。84 名在澳大利亚和新西兰的重症监护病房工作的专家和高级受训人员对 2009 年 2 月至 5 月期间进行的问卷调查做出了回应。
经验性和靶向抗生素治疗，包括给药方式、给药频率、剂量和疗程。
共“开”出了 656 种抗生素，包括 25 种不同的抗生素。82%的病例采用联合治疗，CAP 采用双重覆盖，IAI 采用三联治疗最常见。HAP 中针对铜绿假单胞菌的靶向单药覆盖和治疗耐甲氧西林金黄色葡萄球菌菌血症的氟氯西林单药治疗在 65%和 51%的病例中得到了应用。推荐了支持性庆大霉素治疗（所有病例的 32%），主要采用每日一次剂量。每日庆大霉素剂量为 3 至 7mg/kg（不包括一个异常值），且大部分符合推荐剂量（76%的剂量≥5mg/kg）。与指南不符的主要领域是为耐药菌提供更广泛的覆盖和 Β-内酰胺类药物剂量不足。连续和延长输注并不常见（5%）。
抗生素的使用基本是合适的，但提倡考虑特定部位的耐药情况，并避免剂量不足，以提供适当的初始覆盖，防止剂量不足并降低产生耐药菌的风险。
