Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Claude Bernard University Hospital, Paris, France.
INSERM IAME UMR 1137, University of Paris, Sorbonne Paris Cite, Paris, France.
Semin Respir Crit Care Med. 2021 Oct;42(5):689-697. doi: 10.1055/s-0041-1733987. Epub 2021 Sep 20.
In critically ill patients with sepsis and septic shock, the need for prompt and adequate antibiotic therapy is balanced by the risk of excessive antibiotic exposure that leads to emergence of multidrug-resistant pathogens. As such, antibiotic stewardship programs propose a set of operating rules from antibiotic treatment initiation to de-escalation and finally cessation. In this review, we will describe the rationale for early antibiotic treatment in septic patients, how to optimize initial antibiotic treatment, rules for early treatment discontinuation in pathogen-negative sepsis, and optimal duration of antimicrobial therapy.
在患有败血症和感染性休克的重病患者中，需要迅速和充分的抗生素治疗，这与过度暴露于抗生素导致多药耐药病原体出现的风险相平衡。因此，抗生素管理计划提出了从抗生素治疗开始到降级和最终停止的一系列操作规则。在这篇综述中，我们将描述败血症患者早期抗生素治疗的原理，如何优化初始抗生素治疗，阴性菌败血症早期治疗停止的规则，以及最佳抗菌治疗持续时间。
