Taccone Fabio S, Bond Ottavia, Cavicchi Federica Z, Hites Maya
aDepartment of Intensive Care bDepartment of Infectious Diseases, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Curr Opin Anaesthesiol. 2016 Apr;29(2):166-71. doi: 10.1097/ACO.0000000000000302.
Infections are common complications in critically ill patients and are frequently treated with antibiotics. Unfortunately, delivery of optimal therapy is complicated because efficacy of antimicrobials is influenced by the timing of treatment initiation, the use of combination therapy, and the optimization of drug dosing.
Early diagnosis of infection is mandatory to provide a rapid and appropriate antibiotic therapy. The presence of less susceptible strains, in particular for hospital-acquired infections, or patients with severe disease, such as the presence of septic shock, may need combination antibiotic therapy. Antibiotic pharmacokinetics, notably volume of distribution and total body clearance, are significantly altered in these critically ill patients and can influence the attainment of adequate circulating levels when standard dosage regimens are administered. Higher dosing should be considered in such patients, although in case of renal impairment and reduced clearance, drug accumulation could also result in some side-effects. Nebulized antibiotics may provide a better clinical response than systemic antibiotics in ventilator-associated pneumonia because of multidrug-resistant pathogens.
The optimal use of antibiotics in the management of severe infections is an important challenge for ICU physicians. Antimicrobial therapy needs to be individualized according to specific patient characteristics, infecting organisms, and susceptibility patterns.
感染是重症患者常见的并发症，常需使用抗生素治疗。不幸的是，由于抗菌药物的疗效受治疗开始时间、联合治疗的使用以及给药剂量的优化等因素影响，提供最佳治疗变得复杂。
感染的早期诊断对于提供快速且恰当的抗生素治疗至关重要。对于医院获得性感染或患有严重疾病（如脓毒症休克）的患者，存在较难药敏的菌株时可能需要联合抗生素治疗。在这些重症患者中，抗生素的药代动力学，尤其是分布容积和全身清除率，会发生显著改变，当采用标准给药方案时，这可能会影响达到足够的循环水平。尽管在肾功能损害和清除率降低的情况下，药物蓄积也可能导致一些副作用，但此类患者应考虑更高的给药剂量。对于呼吸机相关性肺炎，由于多重耐药病原体的存在，雾化抗生素可能比全身使用抗生素产生更好的临床反应。
在重症感染的管理中，抗生素的最佳使用是重症监护病房医生面临的一项重要挑战。抗菌治疗需要根据患者的具体特征、感染病原体和药敏模式进行个体化。
