Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.
Chest. 2019 Jul;156(1):163-171. doi: 10.1016/j.chest.2019.01.013. Epub 2019 Jan 25.
In the face of emerging drug-resistant pathogens and a decrease in the development of new antimicrobial agents, antibiotic stewardship should be practiced in all critical care units. Antibiotic stewardship should be a core competency of all critical care practitioners in conjunction with a formal antibiotic stewardship program (ASP). Prospective audit and feedback, and antibiotic time-outs, are effective components of an ASP in the ICU. As rapid diagnostics are introduced in the ICU, assessment of performance and effect on outcomes will clearly be needed. Disease-specific stewardship for community-acquired pneumonia that relies on clinical pathways may be particularly high-yield. Computerized decision support has the potential to individualize stewardship for specific patients. Finally, infection control and prevention is the cornerstone of every ASP.
在面临新出现的耐药病原体和新抗菌药物开发减少的情况下，所有重症监护病房都应实施抗生素管理。抗生素管理应该是所有重症监护从业者的核心能力，同时结合一个正式的抗生素管理项目 (ASP)。前瞻性审核和反馈以及抗生素暂停，是 ICU 中 ASP 的有效组成部分。随着 ICU 中引入快速诊断方法，显然需要评估其性能和对结果的影响。针对社区获得性肺炎的特定疾病的管理，依靠临床路径可能会特别有效。计算机化决策支持有可能为特定患者实现个体化的管理。最后，感染控制和预防是每个 ASP 的基石。
