Di Bella Stefano, Beović Bojana, Fabbiani Massimiliano, Valentini Michael, Luzzati Roberto
Department of Medical, Surgical and Health Sciences, Trieste University, 34127 Trieste, Italy.
Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Antibiotics (Basel). 2020 Jul 10;9(7):398. doi: 10.3390/antibiotics9070398.
"Antimicrobial stewardship" is a strategy that promotes the responsible use of antimicrobials. The objective of this paper is to focus on consolidated and more recent improvements in clinical strategies that should be adopted in hospitalized patients to ameliorate their infectious diseases' outcome and to reduce the antibiotic resistance risk through judicious use of antibiotics. We present 13 common clinical scenarios, the respective suggested interventions and the explanations of the supporting evidence, in order to help clinicians in their decision-making process. Strategies including the choice of antibiotic and dose optimization, antibiotic spectrum narrowing (de-escalation), shortening of duration, shift to oral route or outpatient parenteral antibiotic (including elastomeric pumps), and biomarkers are described and discussed.
“抗菌药物管理”是一种促进抗菌药物合理使用的策略。本文的目的是关注住院患者应采用的临床策略中已巩固的和最新的改进措施，以改善其感染性疾病的预后，并通过合理使用抗生素降低抗生素耐药风险。我们列出了13种常见的临床情况、各自建议的干预措施以及支持证据的解释，以帮助临床医生进行决策过程。文中描述并讨论了包括抗生素选择和剂量优化、抗生素谱缩小（降阶梯）、疗程缩短、转为口服给药或门诊胃肠外抗生素治疗（包括弹力泵）以及生物标志物等策略。
