Ture Zeynep, Güner Rahmet, Alp Emine
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri 38039,Turkey.
Department of Infectious Diseases and Clinical Microbiology, Yıldırım Beyazıt University, Ankara 06800, Turkey.
J Intensive Med. 2022 Nov 15;3(3):244-253. doi: 10.1016/j.jointm.2022.10.001. eCollection 2023 Jul 31.
High resistance rates to antimicrobials continue to be a global health threat. The incidence of multidrug-resistant (MDR) microorganisms in intensive care units (ICUs) is quite high compared to in the community and other units in the hospital because ICU patients are generally older, have higher numbers of co-morbidities and immune-suppressed; moreover, the typically high rates of invasive procedures performed in the ICU increase the risk of infection by MDR microorganisms. Antimicrobial stewardship (AMS) refers to the implementation of coordinated interventions to improve and track the appropriate use of antibiotics while offering the best possible antibiotic prescription (according to dose, duration, and route of administration). Broad-spectrum antibiotics are frequently preferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms. For this reason, a number of studies on AMS in ICUs have increased in recent years. Reducing the use of broad-spectrum antibiotics forms the basis of AMS. For this purpose, parameters such as establishing an AMS team, limiting the use of broad-spectrum antimicrobials, terminating treatments early, using early warning systems, pursuing infection control, and providing education and feedback are used. In this review, current AMS practices in ICUs are discussed.
抗菌药物的高耐药率仍然是一个全球健康威胁。与社区及医院的其他科室相比，重症监护病房（ICU）中多重耐药（MDR）微生物的发生率相当高，这是因为ICU患者通常年龄较大，合并症较多且免疫功能受到抑制；此外，ICU中通常较高的侵入性操作率增加了MDR微生物感染的风险。抗菌药物管理（AMS）是指实施协调一致的干预措施，以改善并跟踪抗生素的合理使用情况，同时提供尽可能最佳的抗生素处方（根据剂量、疗程和给药途径）。由于感染严重程度更高以及MDR微生物的定植和感染，ICU中经常优先选用广谱抗生素。因此，近年来关于ICU中AMS的研究有所增加。减少广谱抗生素的使用是AMS的基础。为此，采用了诸如组建AMS团队、限制广谱抗菌药物的使用、尽早终止治疗、使用预警系统、推行感染控制以及提供教育和反馈等参数。在本综述中，将讨论ICU中当前的AMS实践。
