Cantón R
Rafael Cantón. Servicio de Microbiología. Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid. Spain.
Rev Esp Quimioter. 2021 Apr;34(2):81-92. doi: 10.37201/req/049.2021. Epub 2021 Mar 22.
From a microbiological point of view, both empirical and targeted antimicrobial treatment in respiratory infection is based on the sensitivity profile of isolated microorganisms and the possible resistance mechanisms that they may present. The latter may vary in different geographic areas according to prescription profiles and vaccination programs. Beta-lactam antibiotics, fluoroquinolones, and macrolides are the most commonly used antimicrobials during the exacerbations of chronic obstructive pulmonary disease and community-acquired pneumonia. In their prescription, different aspects such as intrinsic activity, bactericidal effect or their ability to prevent the development of resistance must be taken into account. The latter is related to the PK/PD parameters, the mutant prevention concentration and the so-called selection window. More recently, the potential ecological impact has grown in importance, not only on the intestinal microbiota, but also on the respiratory one. Maintaining the state of eubiosis requires the use of antimicrobials with a low profile of action on anaerobic bacteria. With their use, the resilience of the bacterial populations belonging to the microbiota, the state of resistance of colonization and the collateral damage related to the emergence of resistance to the antimicrobials in pathogens causing the infections and in the bacterial populations integrating the microbiota.
从微生物学角度来看，呼吸道感染的经验性和靶向性抗菌治疗均基于分离出的微生物的敏感性概况以及它们可能呈现的耐药机制。根据处方模式和疫苗接种计划，后者在不同地理区域可能会有所不同。β-内酰胺类抗生素、氟喹诺酮类和大环内酯类是慢性阻塞性肺疾病加重期和社区获得性肺炎期间最常用的抗菌药物。在开具这些药物处方时，必须考虑不同方面，如内在活性、杀菌作用或其预防耐药性产生的能力。后者与药代动力学/药效学参数、突变预防浓度和所谓的选择窗有关。最近，潜在的生态影响变得越来越重要，不仅对肠道微生物群，而且对呼吸道微生物群也是如此。维持微生态平衡状态需要使用对厌氧菌作用较小的抗菌药物。随着这些药物的使用，微生物群中细菌种群的恢复力、定植抵抗状态以及与病原体中抗菌药物耐药性出现相关的附带损害，以及整合到微生物群中的细菌种群都会受到影响。
