Martin-Loeches Ignacio
Department of Anaesthesia and Critical Care Medicine, St James's Hospital, D08 X4RX Dublin, Ireland.
Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, D08 X4RX Dublin, Ireland.
Antibiotics (Basel). 2020 Jul 5;9(7):380. doi: 10.3390/antibiotics9070380.
It is widely known that pneumonia (either community acquired or hospital acquired, as like ventilator associated pneumonia (VAP)), is the most frequent type of severe infection and continues to pose a significant burden on healthcare services worldwide. Despite new diagnostic developments, most pneumonia cases continue to be difficult to diagnose clinically, partly due to acquired antibiotic resistance and the lack of a 'gold standard' method of diagnosis. In other words, the lack of a rapid, accurate diagnostic test, as well as the uncertainty of the initial etiologic diagnosis and the risk stratification, results in empirical antibiotic treatments. There are significant changes in the aetiology of patients with ventilator associated lower respiratory tract infections (VA-LRTI), which are characterised by a higher incidence of multi drug resistant organisms. Evidence suggests that when patients with VA-LRTI develop organ failure, the associated mortality can be exceptionally high with frequent complications, including acute respiratory distress syndrome, acute kidney injury, and septic shock. Appropriate antibiotic treatments must consider that the present cardiovascular failure seen in patients has a different association with the patient's mortality. Unlike patients with less severe clinical presentations, who have a higher chance of survival when the appropriate antibiotics are administered promptly, for patients with a severe subtype of the disease, the appropriateness of antibiotic treatment will impact the patient's outcome to a lesser extent. The present review highlights certain factors detectable at the time of admission that could indicate patients who are at a high risk of bacteraemia and who, therefore, merit more intense therapy and stratified care.
众所周知，肺炎（无论是社区获得性肺炎还是医院获得性肺炎，如呼吸机相关性肺炎（VAP））是最常见的严重感染类型，并且继续给全球医疗服务带来重大负担。尽管诊断技术有了新的发展，但大多数肺炎病例在临床上仍难以诊断，部分原因是获得性抗生素耐药性以及缺乏“金标准”诊断方法。换句话说，由于缺乏快速、准确的诊断测试，以及初始病因诊断和风险分层的不确定性，导致了经验性抗生素治疗。呼吸机相关性下呼吸道感染（VA-LRTI）患者的病因有显著变化，其特点是多重耐药菌的发生率较高。有证据表明，当VA-LRTI患者出现器官衰竭时，相关死亡率可能极高，且并发症频繁，包括急性呼吸窘迫综合征、急性肾损伤和感染性休克。适当的抗生素治疗必须考虑到目前患者出现的心血管衰竭与患者死亡率有不同的关联。与临床表现较轻的患者不同，后者在及时给予适当抗生素时存活几率较高，而对于该疾病严重亚型的患者，抗生素治疗的适当性对患者预后的影响较小。本综述强调了入院时可检测到的某些因素，这些因素可能表明患者有菌血症的高风险，因此值得更强化的治疗和分层护理。
