Mokrani David, Chommeloux Juliette, Pineton de Chambrun Marc, Hékimian Guillaume, Luyt Charles-Edouard
Service de Médecine Intensive Réanimation, Institut de Cardiologie, ICAN, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne-Université, Hôpital Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France.
Ann Intensive Care. 2023 May 6;13(1):39. doi: 10.1186/s13613-023-01134-9.
Antibiotic resistance is a major health problem and will be probably one of the leading causes of deaths in the coming years. One of the most effective ways to fight against resistance is to decrease antibiotic consumption. Intensive care units (ICUs) are places where antibiotics are widely prescribed, and where multidrug-resistant pathogens are frequently encountered. However, ICU physicians may have opportunities to decrease antibiotics consumption and to apply antimicrobial stewardship programs. The main measures that may be implemented include refraining from immediate prescription of antibiotics when infection is suspected (except in patients with shock, where immediate administration of antibiotics is essential); limiting empiric broad-spectrum antibiotics (including anti-MRSA antibiotics) in patients without risk factors for multidrug-resistant pathogens; switching to monotherapy instead of combination therapy and narrowing spectrum when culture and susceptibility tests results are available; limiting the use of carbapenems to extended-spectrum beta-lactamase-producing Enterobacteriaceae, and new beta-lactams to difficult-to-treat pathogen (when these news beta-lactams are the only available option); and shortening the duration of antimicrobial treatment, the use of procalcitonin being one tool to attain this goal. Antimicrobial stewardship programs should combine these measures rather than applying a single one. ICUs and ICU physicians should be at the frontline for developing antimicrobial stewardship programs.
抗生素耐药性是一个重大的健康问题，并且很可能在未来几年成为主要的死亡原因之一。对抗耐药性最有效的方法之一是减少抗生素的使用。重症监护病房（ICU）是抗生素广泛使用的场所，也是经常遇到多重耐药病原体的地方。然而，ICU医生可能有机会减少抗生素的使用并实施抗菌药物管理计划。可能实施的主要措施包括：当怀疑有感染时（休克患者除外，休克患者必须立即使用抗生素），避免立即使用抗生素；对于没有多重耐药病原体危险因素的患者，限制经验性使用广谱抗生素（包括抗MRSA抗生素）；当获得培养和药敏试验结果时，改用单一疗法而非联合疗法，并缩小抗菌谱；将碳青霉烯类药物的使用限制在产超广谱β-内酰胺酶的肠杆菌科细菌感染，将新型β-内酰胺类药物的使用限制在难治性病原体感染（当这些新型β-内酰胺类药物是唯一可用的选择时）；缩短抗菌治疗疗程，降钙素原的应用是实现这一目标的一种手段。抗菌药物管理计划应综合这些措施，而不是仅采用单一措施。ICU和ICU医生应处于制定抗菌药物管理计划的前沿。
