Kolak Radmila R
Klinika za anesteziju i intenzivnu terapiju, Klinicki centar Vojvodine, Novi Sad, Hajduk Veljkova.
Med Pregl. 2010;63 Suppl 1:27-32.
Antibiotics are one the most common therapies administered in the intensive care unit setting. This review outlines the strategy for optimal use of antimicrobial agents in the critically ill.
In severely ill patients, empirical antimicrobial therapy should be used when a suspected infection may impair the outcome.
It is necessary to collect microbiological documentation before initiating empirical antimicrobial therapy. In addition to antimicrobial therapy, it is recommended to control a focus of infection and to modify factors that promote microbial growth or impair the host's antimicrobial defence.
A judicious choice of antimicrobial therapy should be based on the host characteristics, the site of injection, the local ecology, and the pharmacokinetics/pharmacodynamics of antibiotics. This means treating empirically with broad-spectrum antimicrobials as soon as possible and narrowing the spectrum once the organism is identified (de-escalation), and limiting duration of therapy to the minimum effective period.
Despite theoretical advantages, a combined antibiotic therapy is nor more effective than a mono-therapy in curing infections in most clinical trials involving intensive care patients. Nevertheless, textbooks and guidelines recommend a combination for specific pathogens and for infections commonly caused by these pathogens.
Avoiding unnecessary antibiotic use and optimizing the administration of antimicrobial agents will improve patient outcomes while minimizing risks for the development of bacterial resistance. It is important to note that each intensive care unit should have a program in place which monitors antibiotic utilisation and its effectiveness. Only in this way can the impact of interventions aimed at improving antibiotic use be evaluated at the local level.
抗生素是重症监护病房中最常用的治疗方法之一。本综述概述了在危重症患者中优化使用抗菌药物的策略。
在重症患者中，当怀疑感染可能影响预后时，应使用经验性抗菌治疗。
在开始经验性抗菌治疗前，有必要收集微生物学证据。除抗菌治疗外，建议控制感染源并改变促进微生物生长或损害宿主抗菌防御的因素。
明智地选择抗菌治疗应基于宿主特征、注射部位、当地生态以及抗生素的药代动力学/药效学。这意味着尽快使用广谱抗菌药物进行经验性治疗，一旦确定病原体就缩小抗菌谱（降阶梯治疗），并将治疗时间限制在最短有效期限内。
尽管有理论上的优势，但在大多数涉及重症监护患者的临床试验中，联合抗生素治疗在治愈感染方面并不比单药治疗更有效。然而，教科书和指南推荐针对特定病原体以及由这些病原体引起的常见感染使用联合治疗。
避免不必要的抗生素使用并优化抗菌药物的给药将改善患者预后，同时将细菌耐药性产生的风险降至最低。需要注意的是，每个重症监护病房都应制定一个监测抗生素使用及其有效性的计划。只有这样，才能在当地层面评估旨在改善抗生素使用的干预措施的影响。
