腹腔感染治疗中抗生素使用的基本原则、争议与共识
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摘要
复杂腹腔感染(cIAIs)是临床实践中的一大难题。它不仅是导致临床中高发病率及病死率的元凶,还消耗着大量的医疗资源。人口老龄化及其伴随的慢性疾病负担加重影响着cIAIs治疗的成功率,此外医院和社区环境中耐药菌的流行使得c IAIs的治疗更具挑战。在c IAIs的治疗中,除了外科手术、液体复苏之外,抗感染治疗占据着非常重要的地位。一旦怀疑或确诊cIAIs,须尽早给予抗感染治疗,起病初期由于缺乏病原学证据,经验性抗感染治疗尤为重要。抗感染治疗过程中,可根据病原体的培养及其药物敏感性实验结果调整抗感染药物的应用。
Complicated intra-abdominal infections(cIAIs)remain a majorchallenge in clinical practice.In addition to significant morbidity and mortality for patients,they consume substantial hospitalresources.It is compounded by the aging of thepopulation and the burden of chronic disease in these patients,as well as the increased prevalence of resistantbacteria in both the healthcare setting and the community.Besides timely effective source control and fluid resuscitation,rational use of antimicrobials isanintegral part of good clinical practice.Once cIAIs are suspected or diagnosed,anti-infective treatment should be given as soon as possible.At this time,empirical antiinfective treatment is particularly important due to the lack of microbial culture and drug susceptibility results.In the process of anti-infective treatment,the application of anti-infective drugs can be adjusted according to the culture of pathogens and the results of drug sensitivity experiments.
Complicated intra-abdominal infections(cIAIs)remain a majorchallenge in clinical practice.In addition to significant morbidity and mortality for patients,they consume substantial hospitalresources.It is compounded by the aging of thepopulation and the burden of chronic disease in these patients,as well as the increased prevalence of resistantbacteria in both the healthcare setting and the community.Besides timely effective source control and fluid resuscitation,rational use of antimicrobials isanintegral part of good clinical practice.Once cIAIs are suspected or diagnosed,anti-infective treatment should be given as soon as possible.At this time,empirical antiinfective treatment is particularly important due to the lack of microbial culture and drug susceptibility results.In the process of anti-infective treatment,the application of anti-infective drugs can be adjusted according to the culture of pathogens and the results of drug sensitivity experiments.
引文
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[11]Solomkin JS,Mazuski JE,Baron EJ,et al.Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections[J].Clin Infect Dis,2003,37(8):997-1005.
[12]Gomi H,Solomkin JS,Schlossberg D,et al.Tokyo Guidelines2018:antimicrobial therapy for acute cholangitis and cholecystitis[J].J Hepatobiliary Pancreat Sci,2018,25(1):3-16.
[13]Ansaloni L,Pisano M,Coccolini F,et al.2016 WSES guidelines on acute calculous cholecystitis[J].World J Emerg Surg,2016,11:25.
[14]Hensgens MP,Goorhuis A,Dekkers OM,et al.Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics[J].J Antimicrob Chemother,2012,67(3):742-748.
[15]Sartelli M,Weber DG,RuppéE,et al.Antimicrobials:a global alliance for optimizing their rational use in intra-abdominal infections(AGORA)[J].World J Emerg Surg,2016,11(1):33.
[16]Owens RC Jr,Donskey CJ,Gaynes RP,et al.Antimicrobial-associated risk factors for Clostridium difficile infection[J].Clin Infect Dis,2008,46(suppl 1):19-31.
[17]McDonald LC,Gerding DN,Johnson S,et al.Clinical practice guidelines for clostridium difficile infection in adults and chil-··567dren:2017 update by the Infectious Diseases Society of America(IDSA)and Society for Healthcare Epidemiology of America(SHEA)[J].Clin Infect Dis,2018,66(7):987-994.2019-05-02
[2]Solomkin JS,Mazuski JE,Bradley JS,et al.Diagnosis and management of complicated intra-abdominal infection in adults and children:Guidelines by the surgical infection society and the infectious diseases society of America[J].Clin Infect Dis,2010,50(2):133-164.
[3]Mazuski JE,Tessier JM,May AK,et al.The surgical infection society revised guidelines on the management of intra-abdominal infection[J].Surg Infect(Larchmt),2017,18(1):1-76.
[4]王辉,任健康,王明贵.临床微生物学检验[M].北京:人民卫生出版社,2015:8-225.
[5]Sartelli M,Chichom-Mefire A,Labricciosa FM,et al.The management of intra-abdominal infections from a global perspective:2017 WSES guidelines for management of intra-abdominal infections[J].World J Emerg Surg,2017,12:29.
[6]Bedada AG,Hsiao M,Bakanisi B,et al.Establishing a contextually appropriate laparoscopic program in resource-restricted environments:experience in Botswana[J].Ann Surg,2015,261(4):807-811.
[7]Tamma PD,Han JH,Rock C,et al.Carbapenem therapy is associated with improved survival compared with piperacillin-tazobactam for patients with extended-spectrum?-lactamase bacteremia[J].Clin Infect Dis,2015,60(9):1319-1325.
[8]Harris PN,Tambyah PA,Paterson DL,et al.β-lactam andβ-lactamase inhibitor combinations in the treatment of extendedspectrumβ-lactamase producing Enterobacteriaceae:time for a reappraisal in the era of few antibiotic options?[J].Lancet Infect Dis,2015,15(4):475-485.
[9]Montravers P,Gauzit R,Muller C,et al.Emergence of antibioticresistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy[J].Clin Infect Dis,1996,23(3):486-494.
[10]Montravers P,Lepape A,Dubreuil L,et al.Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections:results of the French prospective,observational EBIIA study[J].J Antimicrob Chemother,2009,63(4):785-794.
[11]Solomkin JS,Mazuski JE,Baron EJ,et al.Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections[J].Clin Infect Dis,2003,37(8):997-1005.
[12]Gomi H,Solomkin JS,Schlossberg D,et al.Tokyo Guidelines2018:antimicrobial therapy for acute cholangitis and cholecystitis[J].J Hepatobiliary Pancreat Sci,2018,25(1):3-16.
[13]Ansaloni L,Pisano M,Coccolini F,et al.2016 WSES guidelines on acute calculous cholecystitis[J].World J Emerg Surg,2016,11:25.
[14]Hensgens MP,Goorhuis A,Dekkers OM,et al.Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics[J].J Antimicrob Chemother,2012,67(3):742-748.
[15]Sartelli M,Weber DG,RuppéE,et al.Antimicrobials:a global alliance for optimizing their rational use in intra-abdominal infections(AGORA)[J].World J Emerg Surg,2016,11(1):33.
[16]Owens RC Jr,Donskey CJ,Gaynes RP,et al.Antimicrobial-associated risk factors for Clostridium difficile infection[J].Clin Infect Dis,2008,46(suppl 1):19-31.
[17]McDonald LC,Gerding DN,Johnson S,et al.Clinical practice guidelines for clostridium difficile infection in adults and chil-··567dren:2017 update by the Infectious Diseases Society of America(IDSA)and Society for Healthcare Epidemiology of America(SHEA)[J].Clin Infect Dis,2018,66(7):987-994.2019-05-02