Pourmand Ali, Mazer-Amirshahi Maryann, Jasani Gregory, May Larissa
Department of Emergency Medicine, The George Washington University, Washington, DC, United States; The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States.
Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, United States; Georgetown University School of Medicine, Washington, DC, United States.
Am J Emerg Med. 2017 Aug;35(8):1172-1176. doi: 10.1016/j.ajem.2017.03.010. Epub 2017 Mar 7.
Many bacteria are demonstrating increasing levels of resistance to commonly used antibiotics. While this has implications for the healthcare system as a whole, many patients infected with these resistant organisms will initially present to the emergency department (ED). The purpose of this review is to provide a summary of current trends in infections caused by the most clinically relevant resistant organisms encountered in emergency medicine.
Bacteria were selected based on the Centers for Disease Control and Prevention's National Action Plan for Combating Antibiotic Resistant Bacteria, and PubMed database.
The following bacteria were included: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, Escherichia coli, carbapenem-resistant Enterobacteriaceae, Neisseria gonorrhoeae, and Pseudomonas aeruginosa. All have shown increasing rates of resistance to one or more of the antibiotics commonly used to treat them. Increasing rates of antibiotic resistance are associated with worse clinical outcomes and greater healthcare costs.
Antibiotic resistance is increasing and poses significant a risk to both the patient and public health as a whole. Appropriate choice of initial antibiotic is important in improving clinical outcomes, which is often the role of the ED provider. On a broader level, the ED must also take part in institutional efforts such as Antibiotic Stewardship Programs, which have been shown to decrease costs and rates of infection with resistant organisms. Ultimately, a multifaceted approach will be required to curb the threat of antibiotic-resistant bacteria.
许多细菌对常用抗生素的耐药性正在不断增强。虽然这对整个医疗系统都有影响，但许多感染这些耐药菌的患者最初会前往急诊科就诊。本综述的目的是总结急诊医学中遇到的最具临床相关性的耐药菌引起的感染的当前趋势。
根据疾病控制与预防中心的《抗击抗生素耐药细菌国家行动计划》以及PubMed数据库选择细菌。
纳入的细菌包括：耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、大肠杆菌、耐碳青霉烯类肠杆菌科细菌、淋病奈瑟菌和铜绿假单胞菌。所有这些细菌对一种或多种常用于治疗它们的抗生素的耐药率都在上升。抗生素耐药率上升与更差的临床结局和更高的医疗成本相关。
抗生素耐药性正在增加，对患者和公众健康整体构成重大风险。选择合适的初始抗生素对于改善临床结局很重要，这通常是急诊科医护人员的职责。在更广泛的层面上，急诊科还必须参与诸如抗生素管理计划等机构性工作，这些工作已被证明可以降低成本和耐药菌感染率。最终，需要采取多方面的方法来遏制抗生素耐药细菌的威胁。
