抗生素用药新指南公布！

2016-07-18 MedSci MedSci原创

为了更好地管理抗生素的使用、提高抗生素的治疗效果、减少抗生素相关耐药性、减少院内感染的发生率，新的指南建议，治疗院内肺炎(HAP)与机械通气相关肺炎(VAP)使用的抗生素时长最好不要超过7日。这一新指南由美国传染病学会(IDSA)和美国胸科学会联合颁布,指南还建议,每个医院应开发抗菌谱，同时制定出根据效果选择适合且有效的相应抗生素的治疗规范。内布拉斯加大学医学中心的Andre C. Kalil博士

为了更好地管理抗生素的使用、提高抗生素的治疗效果、减少抗生素相关耐药性、减少院内感染的发生率，新的指南建议，治疗院内肺炎(HAP)与机械通气相关肺炎(VAP)使用的抗生素时长最好不要超过7日。这一新指南由美国传染病学会(IDSA)和美国胸科学会联合颁布,指南还建议,每个医院应开发抗菌谱，同时制定出根据效果选择适合且有效的相应抗生素的治疗规范。

内布拉斯加大学医学中心的Andre C. Kalil博士在IDSA新闻发布会上指出，临床医生若能及时获取导致VAP和HAP的错误操作及有效抗菌谱及适用抗生素信息，便能及时选择有效的治疗方案，既改善了患者的病情，又提高了诊疗技术。这些抗菌谱便可帮助医务人员采取有针对性的治疗方案及护理措施,确保病人使用的是适合本人且正确的抗生素。这项新颁布的指南7月14日发表在Clinical Infectious Diseases。并将取代2005年的旧版本。

Kalil博士领导一个多学科小组在其中发挥了至关重要的作用。他们收集最近发表的系统评价和荟萃分析，在不影响病人安全的前提下得出了该结论。

Kalil博士和同事们注意到,HAP和VAP占院内感染的20%-25%，死亡率占10%-15%。在使用呼吸机的患者中，约1/10的患者会发生VAP，其中13%最终将死亡。

还没有研究表明,长期使用抗生素相比短期使用抗生素有何益处。但是研究人员指出，长期使用抗生素会导致患者发生腹泻、梭状芽胞杆菌感染的风险更大,这极大增加了患者的医疗费用,并导致患者出现抗生素耐药性的风险增加。

因此新指南建议医生使用抗生素治疗VAP和HAP不要超过7天,但他们指出，不能单单依靠指南决定病人的治疗方案，应根据临床、放射学检查资料和实验室检查结果等评估患者应进行抗生素治疗的时长，他们还建议医生尽可能使用窄谱抗菌素替代广谱抗菌素的使用，起始治疗方案采用单药治疗代替联合治疗。指南建议使用血原降钙素水平+临床标准指导停用抗生素治疗的日期,而不是单独根据临床标准停用抗生素。其他相关指南建议采用非侵入性操作诊断VAP,完全依靠临床标准来决定患者是否开始抗生素治疗,但是缺乏实际有效的证据。

研究人员建议各大医院应定期更新抗菌谱，使医务人员可以第一时间内获取有效的抗菌谱信息，更有利于决定患者治疗方案。指南也提出了关于首次感染是否为VAP或HAP、耐甲氧西林金黄色葡萄球菌的风险及其风险的死亡率、革兰氏阳性菌耐药的发生率及抗生素使用等方面的相关建议。
对疑似的VAP患者,指南建议包括金黄色葡萄球菌、铜绿假单胞菌和其他革兰阴性杆菌的治疗方案。对于经验性治疗HAP的患者，研究人员建议使用治疗金黄色葡萄球菌的抗生素。

原始出处：

[1] Guidelines Advise Shorter Antibiotic Course for Pneumonia,Medscape,15,Jul,2016

[2] Andre C. Kalil1.Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society, Clin Infect Dis.2016 July 14.

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2016-10-08 1e10c84am36(暂无匿称)

文章很棒，继续学习

44 0
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2017-06-07 12498768m13(暂无昵称)

#新指南#

29 0
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2016-08-04 ghy_happy

很及时！

59 0
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2016-07-19 doctorJiangchao

抗生素是一门很好的学问

89 0
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2016-07-19 doctorJiangchao

好文章

80 0
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2016-07-19 doctorJiangchao

继续关注

92 0
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2016-07-18 doctorJiangchao

继续学习

38 0

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