Karam George, Chastre Jean, Wilcox Mark H, Vincent Jean-Louis
Infectious Disease Section, Louisiana State University School of Medicine, New Orleans, LA, 70112, USA.
Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.
Crit Care. 2016 Jun 22;20(1):136. doi: 10.1186/s13054-016-1320-7.
The rapid emergence and dissemination of antibiotic-resistant microorganisms in ICUs worldwide threaten adequate antibiotic coverage of infected patients in this environment. The causes of this problem are multifactorial, but the core issues are clear: the emergence of antibiotic resistance is highly correlated with selective pressure resulting from inappropriate use of these drugs. Because a significant increase in mortality is observed when antibiotic therapy is delayed in infected ICU patients, initial therapy should be broad enough to cover all likely pathogens. Receipt of unnecessary prolonged broad-spectrum antibiotics, however, should be avoided. Local microbiologic data are extremely important to predict the type of resistance that may be present for specific causative bacteria, as is prior antibiotic exposure, and antibiotic choices should thus be made at an individual patient level.
全球重症监护病房（ICU）中抗生素耐药微生物的迅速出现和传播，威胁着该环境下感染患者获得足够的抗生素覆盖。这个问题的成因是多方面的，但核心问题很明确：抗生素耐药性的出现与这些药物的不当使用所导致的选择性压力高度相关。由于在感染的ICU患者中，抗生素治疗延迟会导致死亡率显著上升，因此初始治疗应足够广泛，以覆盖所有可能的病原体。然而，应避免不必要地长期使用广谱抗生素。当地的微生物学数据对于预测特定致病细菌可能存在的耐药类型极为重要，既往抗生素暴露情况也是如此，因此抗生素选择应在个体患者层面进行。
