Hebrew University School of Medicine, Jerusalem, Israel; Intensive Care Unit of the Shaare Zedek Medical Center, Jerusalem, Israel.
Department of Anesthesiology and Intensive Care Unit, North Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France; Aix Marseille University, Marseille, France.
Int J Antimicrob Agents. 2023 Apr;61(4):106732. doi: 10.1016/j.ijantimicag.2023.106732. Epub 2023 Jan 20.
In sepsis and septic shock, guidelines recommend administering antimicrobial therapy within the first hour following diagnosis. This recommendation is based on observational studies suggesting that early antimicrobial therapy is associated with improved outcomes. Consequently, front-line physicians are under pressure to quickly decide on the need for antibiotics in patients for whom the diagnosis of sepsis remains uncertain. However, overuse of antibiotics is associated with emergence of multidrug-resistant bacteria, which constitutes a major health issue worldwide. Front-line physicians may be thought to have been responsible for antibiotic overuse in the same patients. This article reports the situation of physicians who are criticised for using unnecessarily antibiotics or those who are criticised for not timeously using antibiotics; it then discusses several options to help the clinician at the bedside.
在脓毒症和感染性休克中，指南建议在诊断后 1 小时内给予抗菌治疗。这一建议基于观察性研究表明，早期抗菌治疗与改善结局相关。因此，一线医生面临着在脓毒症诊断仍不确定的患者中快速决定是否使用抗生素的压力。然而，抗生素的过度使用与多药耐药菌的出现有关，这是全球范围内的一个主要健康问题。一线医生可能被认为对同一患者的抗生素过度使用负有责任。本文报告了因使用不必要的抗生素而受到批评的医生或因未及时使用抗生素而受到批评的医生的情况；然后讨论了一些帮助床边临床医生的选择。
