Kaziani Katerina, Sotiriou Adamantia, Dimopoulos George
a3rd Department of Internal Medicine, Sotiria General Hospital b1st Department of Critical Care Medicine, Evangelismos General Hospital c2nd Department of Critical Care Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University, Athens, Greece.
Curr Opin Infect Dis. 2017 Apr;30(2):221-225. doi: 10.1097/QCO.0000000000000351.
Increasing antimicrobial resistance is a worldwide phenomenon that is threatening public health. Lower respiratory infections are one of the leading causes of morbidity that contribute to antibiotic consumption and thus the emergence of multidrug-resistant microbial strains. The goal of shortening antibiotic regimens' duration in common bacterial infections has been prioritized by antimicrobial stewardship programs as an action against this problem.
Data coming from randomized controlled trials, meta-analyses, and systematic reviews support the shortening of antimicrobial regimens in community-acquired, hospital-acquired, and ventilator-associated pneumonia. Short schedules have been proven at least as effective as long ones in terms of antimicrobial-free days and clinical cure. Procalcitonin-based algorithms have been validated as well tolerated and cost-effective tools for the duration of pneumonia therapy reduction.
Shortening the duration of antibiotic regimens in pneumonia seems a reasonable strategy for reducing selective pressure driving antimicrobial resistance and costs provided that clinical cure is guaranteed. Procalcitonin-based protocols have been proven essentially helpful in this direction. VIDEO ABSTRACT.
抗菌药物耐药性不断增加是一个全球性现象，正威胁着公众健康。下呼吸道感染是导致发病的主要原因之一，促使抗生素的使用，进而导致多重耐药微生物菌株的出现。抗菌药物管理计划将缩短常见细菌感染的抗生素疗程作为应对这一问题的优先行动目标。
来自随机对照试验、荟萃分析和系统评价的数据支持缩短社区获得性肺炎、医院获得性肺炎和呼吸机相关性肺炎的抗菌疗程。就无抗菌药物天数和临床治愈情况而言，短疗程已被证明至少与长疗程一样有效。基于降钙素原的算法已被证实是耐受性良好且具有成本效益的工具，可用于缩短肺炎治疗疗程。
在保证临床治愈的前提下，缩短肺炎抗生素疗程似乎是降低驱动抗菌药物耐药性的选择压力和成本的合理策略。基于降钙素原的方案已被证明在这方面基本是有帮助的。视频摘要。
