Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata, Piazzale S. Maria Della Misericordia 15, 33100, Udine, Italy.
Fourth Department of Internal Medicine, School of Medicine, Attikon University General Hospital, Athens National and Kapodistrian University, 1 Rimini St, 12462, Athens, Greece.
Intensive Care Med. 2017 Oct;43(10):1464-1475. doi: 10.1007/s00134-017-4878-x. Epub 2017 Jul 21.
To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field.
Review of medical literature and expert opinion were used in the development of this review.
There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality. In the last decade, antibiotic stewardship and infection prevention and control have been unable to prevent the rapid spread of resistant Gram-negative bacteria (GNB), in particular carbapenem-resistant Pseudomonas aeruginosa (and other non-fermenting GNB), extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE). The situation appears more optimistic currently for Gram-positive, where Staphylococcus aureus, and particularly methicillin-resistant S. aureus (MRSA), remains a cardinal cause of healthcare-associated infections worldwide. Recent advancements in laboratory techniques allow for a rapid identification of the infecting pathogen and antibiotic susceptibility testing. Their impact can be particularly relevant in settings with prevalence of MDR, since they may guide fine-tuning of empirically selected regimen, facilitate de-escalation of unnecessary antimicrobials, and support infection control decisions. Currently, antibiotics are the primary anti-infective solution for patients with known or suspected MDR bacteria in intensive care. Numerous incentives have been provided to encourage researchers to work on alternative strategies to reverse this trend and to provide a means to treat these pathogens. Although some promising antibiotics currently in phase 2 and 3 of development will soon be licensed and utilized in ICU, the continuous development of an alternative generation of compounds is extremely important. There are currently several promising avenues available to fight antibiotic resistance, such as faecal microbiota, and phage therapy.
描述目前关于抗生素耐药性（AMR）的治疗标准和主要的最新进展，并对该领域未来 30 年进行前瞻性概述。
本文通过对医学文献的综述和专家意见进行了研究。
ICU 中 AMR 确实存在较大的临床和公共卫生负担，但量化相关的发病率和死亡率增加具有挑战性。在过去十年中，抗生素管理和感染预防与控制未能阻止耐药革兰氏阴性菌（GNB）的快速传播，特别是耐碳青霉烯类铜绿假单胞菌（和其他非发酵 GNB）、产超广谱β-内酰胺酶（ESBL）和耐碳青霉烯类肠杆菌科（CRE）。目前，革兰氏阳性菌的情况似乎更加乐观，金黄色葡萄球菌，特别是耐甲氧西林金黄色葡萄球菌（MRSA），仍然是全球范围内导致医疗保健相关感染的主要原因。实验室技术的最新进展可以快速鉴定感染病原体和进行抗生素药敏试验。在耐药率高的情况下，它们的影响可能特别重要，因为它们可以指导对经验性选择方案进行微调，促进不必要的抗生素降级，并支持感染控制决策。目前，抗生素是 ICU 中已知或疑似耐多药细菌患者的主要抗感染解决方案。为了鼓励研究人员研究替代策略来扭转这一趋势并提供治疗这些病原体的方法，已经提供了许多激励措施。尽管目前有一些有前途的抗生素处于 2 期和 3 期开发阶段，很快将在 ICU 中获得许可和使用，但不断开发新一代化合物非常重要。目前有几种有前途的方法可用于对抗抗生素耐药性，例如粪便微生物群和噬菌体治疗。
