Matuszak Sarah Singer, Kolodziej Lauren, Micek Scott, Kollef Marin
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
Department of Pharmacy Practice, University of Health Sciences and Pharmacy, St. Louis, MO 63110, USA.
Antibiotics (Basel). 2025 May 3;14(5):467. doi: 10.3390/antibiotics14050467.
Antibiotic de-escalation (ADE) is important to help optimize antibiotic use and balance the positive and negative effects of antimicrobial therapy. ADE should be performed promptly, and infections should be treated with the shortest course of antimicrobials as clinically feasible to avoid unnecessary use of broad-spectrum antimicrobials. Several tools have been developed to increase efficient ADE, including rapid diagnostic tests (ex. multiplex PCR), MRSA nasal PCR/culture, and biomarkers. Multiplex PCR and MRSA nasal PCR/culture have been associated with reductions in inappropriate antibiotic use. Procalcitonin, a biomarker, has been associated with shorter antimicrobial durations in some studies; however, widespread use may be limited by lack of specificity for bacterial infections, cost, and lack of set cut-off points. Additional biomarkers such as IL-6, HMGB1, presepsin, sTREM-1, CD64, PSP, proadrenomedullin, and pentraxin-3 are currently being studied. As technology improves, additional tools may be leveraged to better optimize ADE even better, such as antimicrobial spectrum scoring tools and artificial intelligence (AI). Spectrum scores, which quantify antibiotic activity using specific numeric values, could be incorporated into electronic health records to identify patients on unnecessarily broad antibiotics. AI modeling has the potential to predict personal antibiograms or provide the probability that an empiric regimen may cover a particular infection, among other potential applications. This review will discuss the literature associated with ADE in the ICU, selected tools to help guide ADE, and perspectives on how to implement ADE into clinical practice.
抗生素降阶梯治疗（ADE）对于优化抗生素使用以及平衡抗菌治疗的正负效应非常重要。应及时进行ADE，并且在临床可行的情况下，使用最短疗程的抗菌药物治疗感染，以避免不必要地使用广谱抗菌药物。已经开发了多种工具来提高ADE的效率，包括快速诊断检测（如多重PCR）、耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔PCR/培养以及生物标志物。多重PCR和MRSA鼻腔PCR/培养与减少不适当的抗生素使用有关。生物标志物降钙素原在一些研究中与缩短抗菌疗程有关；然而，其广泛应用可能受到对细菌感染缺乏特异性、成本以及缺乏设定的临界值的限制。目前正在研究其他生物标志物，如白细胞介素-6（IL-6）、高迁移率族蛋白B1（HMGB1）、可溶性髓系细胞触发受体-1（sTREM-1）、CD64、肺表面活性蛋白（PSP）、前肾上腺髓质素和五聚素-3。随着技术的进步，可能会利用更多工具来更好地优化ADE，例如抗菌谱评分工具和人工智能（AI）。谱评分使用特定数值量化抗生素活性，可纳入电子健康记录以识别使用不必要广谱抗生素的患者。AI建模有可能预测个人抗菌谱，或提供经验性治疗方案覆盖特定感染的概率等其他潜在应用。本综述将讨论与ICU中ADE相关的文献、有助于指导ADE的选定工具以及关于如何将ADE应用于临床实践的观点。
