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严重脓毒症和脓毒性休克的早期抗菌治疗。

Early antimicrobial therapy in severe sepsis and septic shock.

机构信息

Section of Critical Care Medicine, Section of Infectious Diseases, JJ399d, Health Sciences Centre, 700 William Street, Winnipeg, Manitoba, R3A 1R9, Canada,

出版信息

Curr Infect Dis Rep. 2010 Sep;12(5):336-44. doi: 10.1007/s11908-010-0128-x.

Abstract

The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in the case fatality rates of serious infections, including septic shock. Since then, pathogens have continuously evolved under selective antimicrobial pressure, resulting in a lack of additional significant improvement in clinical effectiveness of antimicrobial therapy of septic shock despite ever more broad-spectrum and potent drugs. In addition, although substantial effort and money were expended on the development of novel nonantimicrobial therapies of sepsis in the past 30 years, clinical progress in this regard has been limited. This article explores the possibility that the key to significant improvement in the outcome of septic shock may lie, in great part, with improvements in delivery of existing antimicrobials. Recognizing the role of delays in administration of antimicrobial therapy in the poor outcomes of septic shock is central to this effort.

摘要

自 20 世纪 40 年代青霉素发现以来,现代抗菌治疗的出现显著降低了严重感染(包括感染性休克)的病死率。此后,病原体在抗菌药物的选择性压力下不断进化,尽管不断开发出更加广谱和强效的药物,但感染性休克抗菌治疗的临床疗效仍无明显提高。此外,尽管过去 30 年来在脓毒症的新型非抗菌治疗方法的研发上投入了大量的精力和资金,但这方面的临床进展仍很有限。本文探讨了这样一种可能性,即改善感染性休克预后的关键可能在很大程度上取决于现有抗菌药物的应用方式的改进。认识到抗菌治疗延迟在感染性休克不良结局中的作用是这一努力的核心。

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