Creel Joseph P, Maves Ryan C
Section of Infectious Diseases, Department of Internal Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Section of Critical Care Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Surg Infect (Larchmt). 2023 Apr;24(3):220-225. doi: 10.1089/sur.2022.422.
The human microbiome plays a critical role in health and disease. The microbiota of the human body undergoes disruptions in critical illness, in part due to alterations in physiology but also as the result of medical interventions, most notably antimicrobial drug administration. These alterations may lead to a significant dysbiosis, with increased risks of multi-drug-resistant organism-based secondary infections, promotion, and other infection-related complications. Antimicrobial stewardship is a process that seeks to optimize antimicrobial drug prescription, with recent evidence emphasizing shorter courses of therapy, earlier transitions from empiric to pathogen-specific regimens, and enhanced diagnostic testing. Through a combination of prudent stewardship and wise use of diagnostic testing, clinicians can improve outcomes, reduce the risk of antimicrobial resistance, and help improve the integrity of the microbiome.
人类微生物组在健康和疾病中起着关键作用。人体微生物群在危重病中会发生紊乱，部分原因是生理改变，但也是医疗干预的结果，最显著的是抗菌药物的使用。这些改变可能导致严重的生态失调，增加基于多重耐药菌的继发感染、病情进展及其他感染相关并发症的风险。抗菌药物管理是一个旨在优化抗菌药物处方的过程，最近的证据强调缩短治疗疗程、从经验性治疗更早地过渡到针对病原体的治疗方案以及加强诊断检测。通过审慎的管理和明智地使用诊断检测相结合，临床医生可以改善治疗效果、降低抗菌药物耐药性风险，并有助于改善微生物组的完整性。
