Kullberg Robert F J, Haak Bastiaan W, Chanderraj Rishi, Prescott Hallie C, Dickson Robert P, Wiersinga W Joost
Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Lancet Respir Med. 2025 Jan;13(1):92-100. doi: 10.1016/S2213-2600(24)00257-1. Epub 2024 Oct 11.
Antibiotics are fundamental in sepsis management; however, the optimal empirical treatment remains debated. Despite anaerobes rarely being the causative pathogen of sepsis, antibiotics targeting them are frequently used, which might lead to unintended consequences. Multiple studies have shown that depletion of commensal anaerobic gut microbes by anti-anaerobic antibiotics influences systemic immunity and is associated with increased mortality in patients with sepsis. However, this knowledge has not yet been translated into clinical practice. When considering empirical coverage of anaerobic pathogens in sepsis, most physicians advocate for a better-safe-than-sorry approach. In this Viewpoint, we argue that anti-anaerobic antibiotics could often result in being sorry rather than safe. We provide an overview of the limited necessity of anaerobic coverage and the potential detrimental effects of anaerobic depletion in sepsis. We aim to raise anaerobic awareness to reduce the unnecessary use of anti-anaerobic antibiotics in empirical sepsis treatment and improve patient outcomes.
抗生素在脓毒症治疗中至关重要；然而，最佳经验性治疗方案仍存在争议。尽管厌氧菌很少成为脓毒症的致病病原体，但针对它们的抗生素却经常被使用，这可能会导致意想不到的后果。多项研究表明，抗厌氧抗生素导致共生厌氧肠道微生物减少会影响全身免疫，并与脓毒症患者死亡率增加有关。然而，这一认识尚未转化为临床实践。在考虑脓毒症中厌氧病原体的经验性覆盖时，大多数医生主张采取宁求稳妥以免遗憾的方法。在本观点中，我们认为抗厌氧抗生素往往会导致遗憾而非安全。我们概述了厌氧覆盖的必要性有限以及脓毒症中厌氧微生物减少的潜在有害影响。我们旨在提高对厌氧菌的认识，以减少经验性脓毒症治疗中抗厌氧抗生素的不必要使用，并改善患者预后。
