Stegemann Miriam
Klinik für Infektiologie und Intensivmedizin, Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Med Klin Intensivmed Notfmed. 2023 Sep;118(6):477-482. doi: 10.1007/s00063-023-01047-2. Epub 2023 Aug 11.
The spread of antimicrobial resistance (AMR) is one of the greatest threats to global health and causes very many deaths. Also in the context of sepsis-the severest complication of certain infectious diseases-does AMR play a role. Wise use of anti-infectives and application of antibiotic stewardship (AMS) principles can reduce the spread of AMR and improve the quality of management of patients with infectious diseases. Correct use of anti-infective agents includes the correct diagnostic approach and documentation of the (suspected) diagnosis, guideline-conform diagnostic workup and treatment selection, re-evaluation and tailoring during the course of treatment, a focus on treatment de-escalation depending on clinical response and microbiology results, dose optimization, and, if possible, conversion to oral therapy, and early termination of treatment if the suspected diagnosis is not confirmed. Particularly adherence to the guideline-conform treatment duration can reduce unnecessary use of anti-infectives. Prevention of infections via adherence to vaccination recommendations also contributes to a reduction in the use of anti-infectives. Interdisciplinary collaboration with infectious diseases and AMS specialists, as recommended for sepsis, also improves treatment quality and patient outcomes. Particularly for complex infections such as endocarditis cases should be discussed in multidisciplinary teams including specialists in infectious diseases. In this manner, decisive steps against the spread of AMR and towards maintenance of the efficacy of available anti-infective drugs can be taken.
抗菌药物耐药性（AMR）的传播是对全球健康的最大威胁之一，并导致众多死亡。在脓毒症（某些传染病最严重的并发症）的背景下，AMR也起着一定作用。明智地使用抗感染药物并应用抗生素管理（AMS）原则可减少AMR的传播，并提高传染病患者的管理质量。正确使用抗感染药物包括正确的诊断方法和（疑似）诊断的记录、符合指南的诊断检查和治疗选择、治疗过程中的重新评估和调整、根据临床反应和微生物学结果关注治疗降阶梯、剂量优化、尽可能转换为口服治疗，以及如果疑似诊断未得到证实则尽早终止治疗。特别是遵守符合指南的治疗持续时间可减少抗感染药物的不必要使用。通过遵守疫苗接种建议预防感染也有助于减少抗感染药物的使用。如针对脓毒症所建议的，与传染病和AMS专家进行跨学科合作也可提高治疗质量和患者预后。特别是对于复杂感染，如心内膜炎，病例应在包括传染病专家的多学科团队中进行讨论。通过这种方式，可以采取果断措施来对抗AMR的传播并维持现有抗感染药物的疗效。
