医学
重症监护医学
抗生素耐药性
美罗培南
感染性休克
抗菌管理
抗菌剂
他唑巴坦
抗生素
败血症
亚胺培南
微生物学
免疫学
生物
作者
Alexis Tabah,Niccolò Buetti,François Barbier,Jean‐François Timsit
出处
期刊:Current Opinion in Infectious Diseases
[Ovid Technologies (Wolters Kluwer)]
日期:2021-07-22
卷期号:34 (6): 718-727
被引量:6
标识
DOI:10.1097/qco.0000000000000767
摘要
The COVID-19 pandemic has caused multiple challenges to ICUs, including an increased rate of secondary infections, mostly caused by Gram-negative micro-organisms. Worrying trends of resistance acquisition complicate this picture. We provide a review of the latest evidence to guide management of patients with septic shock because of Gram-negative bacteria.New laboratory techniques to detect pathogens and specific resistance patterns from the initial culture are available. Those may assist decreasing the time to adequate antimicrobial therapy and avoid unnecessary broad-spectrum antibiotic overuse. New antimicrobials, including β-lactam/β-lactamase inhibitor combinations, such as ceftolozane-tazobactam, imipenem-relebactam or meropenem-vaborbactam and cephalosporins, such as cefiderocol targeted to specific pathogens and resistance patterns are available for use in the clinical setting. Optimization of antibiotic dosing and delivery should follow pharmacokinetic and pharmacodynamic principles and wherever available therapeutic drug monitoring. Management of sepsis has brought capillary refill time back to the spotlight along with more reasoned fluid resuscitation and a moderate approach to timing of dialysis initiation.Novel rapid diagnostic tests and antimicrobials specifically targeted to Gram-negative pathogens are available and should be used within the principles of antimicrobial stewardship including de-escalation and short duration of antimicrobial therapy.
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