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临终感染与新出现的抗菌药物耐药性困境:一项范围综述

End-of-Life Infections and the Dilemma of Emerging Antimicrobial Resistance: A Scoping Review.

作者信息

Alwazzeh Marwan Jabr

机构信息

Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.

出版信息

Infect Chemother. 2025 Mar;57(1):1-12. doi: 10.3947/ic.2024.0088.

Abstract

The goals of antimicrobial treatment of end-of-life (EOL) infections are variously defined, raising complex questions about the management futility, ethical aspects, psychosocial burden, and the risk of emerging antimicrobial resistance. The author searched PubMed, Scopus, and Web of Science databases to retrieve relevant articles published from May 1, 2000, to April 30, 2024, on EOL infections and emerging multidrug-resistant organisms. The titles and abstracts of retrieved articles were screened, duplicate records were excluded, and the eligibility of selected papers was assessed. Sixty-one articles were included; the prevalence of EOL infections and antimicrobial therapy were calculated, the common sites and characteristics of EOL infections were identified, and the extent of emerging multidrug-resistant organisms among EOL patients, especially the "superbugs" ones, were estimated. The review indicates that infections are common in terminally ill patients, the prevalence of irrational antimicrobial prescriptions is high globally, with antimicrobials frequently administered until death. Limited data regarding antimicrobial resistance are available, and they cover short periods, while many of those patients survive longer with modern healthcare and become an essential reservoir for emerging multidrug-resistant organisms. This underscores the importance of antimicrobial stewardship programs and the urgent need for further research in this often-overlooked study area.

摘要

临终(EOL)感染的抗菌治疗目标定义各异,引发了关于治疗无用性、伦理问题、心理社会负担以及新出现的抗菌药物耐药性风险等复杂问题。作者检索了PubMed、Scopus和科学网数据库,以获取2000年5月1日至2024年4月30日期间发表的有关EOL感染和新出现的多重耐药菌的相关文章。对检索到的文章标题和摘要进行筛选,排除重复记录,并评估所选论文的合格性。纳入了61篇文章;计算了EOL感染的患病率和抗菌治疗情况,确定了EOL感染的常见部位和特征,并估计了EOL患者中尤其是“超级细菌”等新出现的多重耐药菌的程度。该综述表明,感染在晚期患者中很常见,全球不合理抗菌药物处方的患病率很高,抗菌药物经常一直使用到患者死亡。关于抗菌药物耐药性的数据有限,且涵盖时间较短,而随着现代医疗保健的发展,许多此类患者存活时间更长,成为新出现的多重耐药菌的重要储存库。这凸显了抗菌药物管理计划的重要性以及在这个经常被忽视的研究领域进行进一步研究的迫切需求。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17ac/11972908/08785f8ea118/ic-57-1-g001.jpg

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