Guervil David J, Chau Terence
Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, 77030, USA.
Crit Care Nurs Q. 2013 Oct-Dec;36(4):345-55. doi: 10.1097/CNQ.0b013e3182a10d2f.
Multidrug-resistant gram-negative bacilli are emerging threats in the intensive care unit setting worldwide. Extended-spectrum β-lactamases, AmpC β-lactamases, and carbapenem-resistant Enterobacteriaceae are increasing at an alarming rate, leaving limited therapeutic options. In addition, multidrug resistance among Pseudomonas aeruginosa and Acinetobacter baumannii has widely disseminated and become a frequent cause of nosocomial infections within many intensive care units. Therefore, resistance is increasing to all currently available antibiotics, including cephalosporins, penicillins, aztreonam, carbapenems, fluoroquinolones, and aminoglycosides. Some multidrug-resistant gram-negative bacteria remain susceptible to only a few antibiotics such as tigecycline, fosfomycin, and polymyxins. The steady trend of increasing resistance coupled with the lack of novel antibiotics targeting resistant gram-negative bacilli has forced clinicians to increasingly apply more aggressive dosing strategies, such as prolonged and continuous infusion of β-lactam antibiotics to address the challenges associated with these difficult-to-treat pathogens. Nurses who have a thorough understanding of antibiotic resistance patterns, infection control procedures, and appropriate antibiotic use and dosing regimens, particularly the method of administration, are essential in the battle to preserve the usefulness of antibiotics and prevent further antibiotic resistance.
多重耐药革兰氏阴性杆菌在全球范围内的重症监护病房中构成了新的威胁。超广谱β-内酰胺酶、AmpCβ-内酰胺酶和耐碳青霉烯类肠杆菌科细菌正以惊人的速度增加，使得治疗选择极为有限。此外，铜绿假单胞菌和鲍曼不动杆菌的多重耐药性已广泛传播，成为许多重症监护病房医院感染的常见原因。因此，目前所有可用抗生素，包括头孢菌素、青霉素、氨曲南、碳青霉烯类、氟喹诺酮类和氨基糖苷类的耐药性都在增加。一些多重耐药革兰氏阴性菌仅对少数抗生素敏感，如替加环素、磷霉素和多粘菌素。耐药性持续上升的趋势，加上缺乏针对耐药革兰氏阴性杆菌的新型抗生素，迫使临床医生越来越多地采用更积极的给药策略，如延长和持续输注β-内酰胺类抗生素，以应对与这些难以治疗的病原体相关的挑战。对抗生素耐药模式、感染控制程序以及适当的抗生素使用和给药方案，特别是给药方法有透彻了解的护士，对于维护抗生素的有效性和防止进一步的抗生素耐药性至关重要。
