Optimised antimicrobial treatment to counter bacterial resistance

bacterial resistance can lead to increased infection rates, longer infection duration, increased inappropriate treatment, longer hospital stays, increased medical costs, and even increased mortalityAntibacterial treatment should not only consider the development of individualized programs to improve the success rate of treatment, but also pay attention to slow the occurrence and development of drug resistance, that is, pay attention to how to optimize antimicrobial treatmentreasonable antimicrobial treatment
to develop a reasonable antimicrobial treatment plan generally to consider the following aspects of the content:, fully estimate possible pathogens, master the common pathogens of different infections, so that antimicrobial treatment to achieve "targeted.":: Fully grasp the status quo of pathogen resistance and select sensitive antimicrobialsThe choice of antimicrobial drugs should not rely on the effective antibacterial spectrum of an early drug research and development, but should dynamically understand the international, domestic, regional,hospital
s and even the treatment area of the pathogen resistance and resistance characteristics, choose sensitive antimicrobial drugs:: Develop correct use of antimicrobials based on pharmacokinetics and/or pharmacodynamics (PK/PD) theories:: Take full account of the physiological and pathophysiological conditions of the patient, select safe drugs and adjust the dose of the administration:: Take full account of other factors that may affect treatmentSuch as the choice of antidote or fungicides, single medicine or combination of drugs, as well as the course of treatment and other issuesOptimizing antimicrobial treatment strategies
lower-down-ladder therapy
therapy is a holistic treatment of two different stages, that is, "empirical treatment" and "target therapy", both of which should be unified and organicAt present, it is believed that the lower ladder treatment can not only provide appropriate initial treatment for patients with high risk factors of drug-resistant bacterial infection, but also avoid unnecessary use of antimicrobial drugsThe principle of broad coverage should be followed in the initial treatment of a serious infectionThere is growing evidence that failure of initial treatment can lead to increased mortalityInappropriate initial treatment refers to the failure of the antimicrobial used to cover the target pathogen, or the target pathogen's resistance to the antimicrobial usedWith drug-resistant bacteria infection risk factors of infection, its initial treatment should take a combination of treatment to cover the most likely pathogensClear pathogen diagnosis should be followed by the stair treatment, which refers to once the pathogen diagnosis is clear, should be immediately changed to sensitive and targeted narrow spectrum antibacterial drugsThe aim is to improve the patient's prognosis, reduce the production of drug-resistant strains, and avoidadverse reactionsand complications caused by long-term broad-spectrum antibacterial treatmentHowever, there are a few things worth noting when implementing the lower-down ladder therapy:- and lower-step treatment should target serious, life-threatening infections:: The choice of the lower-level treatment plan should strive to achieve "in place without offside", requiring the individual choice of antimicrobialsTo "in place" easy, to achieve "not offside" difficult, the key lies in the judgment of pathogen resistanceClinically severe infections are not all drug-resistant bacteria, and sensitive bacteria can also cause severe infections (e.g pulmonary spore disease, etc.) The treatment plan of "Taineng (amine peran and sistatin) gwasanamycin" is really inappropriate, in fact, the program is proposed for late severe respiratory-related pneumonia, rather than the "magic medicine" that is all-round :: Pathogen diagnosis remains a major concern for clinicians, and specimens should be taken for culture and drug sensitivity testing as far as possible before empirical treatment Recent meta-analysis of four randomized trials showed that continuous bacterial culture of lower respiratory tract secretions helped to move quickly from broad-spectrum empirical therapy to targeted health-level treatment Short-range treatment strategies research and promotion of short-term treatment begins with the treatment of tuberculosis, malaria and sexually transmitted diseases , while the treatment of common bacterial infections is not rigorously studied In recent years, it has been recognized that the inappropriate extension of the course of treatment and the increase in exposure time of antimicrobialdrugs is one of the important reasons for the increase in drug resistance With the emergence of fast-acting antimicrobial drugs, the research on PK/PD of antimicrobial drugs has been carried out, and the treatment of short courses of bacterial infection has attracted attention and research For the antimicrobial treatment of chronic obstructive pulmonary disease (AECOPD) in acute exacerbation, clinicians usually perform a course of course of 10 to 14 days However, the study of 6629 AECOPD antimicrobial treatments published between 1998 and 2001 showed that the three-to-five-day course of treatment of different drugs was comparable to the clinical and bacteriological efficacy of the 8 to 14-day course Singh and other patients with suspected ventilator-related pneumonia (VAP) received 3 days of short course of treatment or routine 10 to 21 days of antimicrobial treatment, and found that short course of treatment and long course of clinical effects are similar, and the occurrence of drug-resistant bacteria bi-infected fewer Ibrahim et al used pharmacist-directed treatment regimens in the ICU to reduce THE application of VAP antibiotics from (14.8 to 8.1) days to (8.1 x 5.1) days (P 0.001) a recent multicenter randomized control in Europe The study showed that, in addition to non-fermented bacteria such as copper-green pseudomonascobacteria, there was no significant difference between the mortality and recurrence rates of the antimicrobial treatment 8 days and the 15-day treatment group, while the number of days without antibiotics in the short course group was significantly longer than in the long course group, and the infection rate of multidrug-resistant gram-negative bacteria decreased significantly in the recurrence cases Combination therapy combined treatment has been successfully used in anti-TB treatment, which can reduce the occurrence of drug resistance However, there is no convincing evidence in HAP treatment Similarly, there is a lack of conclusive evidence of acquired infections hospitals However, there is some circumstantial evidence that combination therapy may be useful Danish scholars analyzed the resistance of 8,840 strains of 7,938 strains of mycobacterium disease isolated in a region between 1981 and 1995, and the results showed that E coli bacteria had low levels of resistance to three generations of cephalosporine, carbon penicillin, aminoglycosine and fluoroquinolones.) 1%), and in the region's empirical treatment of penicillin or ampicillin combined with amino glycoside stakes accounted for 94%, which suggests that the long-term use of combined narrow-spectrum antimicrobials may help inhibit resistance to broad-spectrum antimicrobials, and can effectively treat severe infections, including mycoplasma , in addition to preventing resistance, combined treatment may be more effective In high-risk cases of pathogenic infections such as copper-green pseudomonas, it may help to improve prognosis by using empirical combination therapy before drug sensitivity results come out Conversion therapy in conversion therapy, from vein to oral sequential treatment has important clinical significance Studies have shown that early conversion from venous to oral therapy will reduce costs, reduce hospital stays, and reduce the incidence of hospital-related complications Guidelines for optimizing clinical management of antimicrobials
national or local guidelines for the application of antimicrobials can help avoid unnecessary use of antimicrobials and improve efficacy, but even mature guidelines are not necessarily widely accepted Prescription restrictions have been shown to limit the use of certain or certain types of antimicrobials to reduce the cost of restricting drugs and the adverse effects of drugs However, due to methodological problems, it is difficult to prove that restricting prescriptioncan effectively controls drug resistance or improves efficacy However, limiting prescription strategies in the event of an outbreak of drug-resistant bacterial infection is effective, especially by strengthening infection control measures, and educating physicians If it is difficult to identify Clostridium difficile-related diarrhea outbreaks related to antibiotic use and abuse, after taking strict measures to limit the use of clinkinin, it is difficult to identify clostridium-related diarrhea cases stable reduction Antibacterial drug replacement antimicrobial replacement or intervention refers to the outbreak of drug-resistant bacteria in a certain range of epidemic, in order to treat drug-resistant bacteria infection, control the epidemic of drug-resistant bacteria for the purpose of strategic replacement of primary anti-infection program Antibacterial drugs used for replacement are effective against major drug-resistant bacteria and do not induce or induce other drug-resistant bacteria At present, the outbreak of drug-resistant bacteria in clinical practice is mainly resistant to the third generation of cephalosporins gram-negative bacteria, of which the more serious drug resistance of the third generation of cephalosporine, cephalosporine and cephalosporine and so on There have been many replacement studies on these drug resistances, including amine perinan,cephalosporine, cephalosporine, pyraclin,taxilin-clavin-cytaminn, and ampicillin-supbatan, among which there has been more research on psilasillin and thaprenitin However, there are limited studies on the replacement of antimicrobials, and the effectiveness of the drug needs further research, especially with attention to the long-term use of newly selected antimicrobials Antibiotic rotation antibiotic rotation is a certain treatment plan for a drug-referenced patient at a predetermined time, followed by a predetermined time for the same drug refers to the patient to replace another treatment plan There are at least 2 or more treatment options for rotation and are used interchangeably The starting point for antibiotic rotation is that the new treatment plan will help reduce resistance to the previous programme, restore the value of initial antibiotic treatment, make it more effective in future treatments, and reduce the selective pressure of antibiotics The rotation of antibiotic types is recommended as a potential strategy to reduce the occurrence of drug resistance However, so far the relevant research has been limited Gerding and others evaluated the effectiveness
of the 10-year rotation of Amica star and Gingdamycin conducted at the Minneapolis Veterans Hospital, with a rotation period of 12 to 51 months It was found that the resistance to chingmycin decreased significantly when amika sin was used, but its resistance re-emerged when the use of ginghamycin was increased again rapidly The use of gingestymycin increased gradually in the second rotation after that, and as a result, its resistance did not increase The results suggest that antibiotic rotation in similar drugs may be an effective strategy to curb resistance in certain situations Studies such as Gruson have found that the incidence of VAP can be reduced through the development of an antimicrobial use program that includes the rotation of guided antimicrobials and restrictions on the use of cephalosporine and ciprofloxacin, both of which have been widely used Antibacterial drug selection is based on monthly separation of pathogens and their drug sensitivity results The results showed that the incidence of VAP decreased mainly due to the reduction of VAP caused by drug-resistant gram-negative bacteria, such as copper-green pseudomonas, onion Bockfeld bacteria, stylized malt narrow-food monospores and Baumann's monospora Concerned about the additional damage of antimicrobials
so-called additional damage refers to the non-purpose effects of antimicrobials on the microbiome, including the screening of drug-resistant strains, multidrug-resistant strains and increased pathogenicity strains, as well as the promotion of implantation and increased pathogenicity of infected strains Studies have shown that there are significant differences in additional damage caused by different antibiotics Such as the use of three generations of cephalosporins and the production of ultra-broad-spectrum beta lactamine strains, methicillin-resistant Staphylococcus aureus, resistant to vancomycin enterococci and hard-to-identify Clostridium difficium bacteria The use of carbon penicillin antibiotics is associated with the production of multidrug-resistant Baumannanitus and copper-green pseudomonas, while the use of quinolones is associated with the production of all of the drug-resistant pathogens mentioned above Therefore, not only the use of antimicrobial drugs should be given full attention to its additional damage, but also in the clinical management of antimicrobialdrugs should also be considered, so that the variety of antimicrobial drugs, quantity and so on more in line with the overall requirements of controlling bacterial resistance Summary in short, in today's increasing resistance to antimicrobialdrugs, clinicians and antimicrobial management departments have put forward higher requirements Optimizing treatment not only optimizes treatment options, but also optimizes clinical management so that infectioncane infections can be treated while reducing the production of drug-resistant bacteria and contributing to reducing bacterial resistance (Chen Yiyi)