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摘要: 科学技术进步带来的医学发展，对包括感染在内的很多疾病诊疗水平的提高作出了巨大贡献。但不可否认的是，感染依旧是威胁人类健康的重要病种。即便最先进的病原鉴定技术，也没能改变感染性疾病早期诊疗实践中，以感染内科医生为主体的经验性治疗和综合判断为主要手段的诊疗模式。因此，在我国目前感染专科医生普遍比较匮乏的现状下，如何提高临床医生对感染性疾病的综合诊疗能力，在接诊早期制定出符合患者后续诊疗需要的方案至关重要。本文拟结合临床实践和国际先进经验，对感染性疾病的诊疗思路进行梳理，以期为临床医生提供借鉴。Abstract: he medical development brought about by the progress of science and technology has made great contributions to the improvement of diagnosis and treatment of many diseases including infection. However, it is undeniable that infection is still an important disease threatening human beings. Even the most advanced technique of pathogen identification still cannot change the model of empirical treatment and comprehensive judgment, which is the main module of early diagnosis and treatment of infectious diseases (ID). Therefore, how to improve the comprehensive diagnosis and treatment of ID by clinicians is very important in the early diagnosis and treatment, especially in the current situation of general lack of ID specialists in our country. This article is to combine basic skills of clinical practice and international advanced experience to sort out the diagnosis and treatment of ID, in order to provide a feasible reference for clinicians.
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Key words:
- infectious diseases /
- infectious diseases specialist /
- diagnosis /
- treatment
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[1] http://www.who.int/news-room/fact-sheets/detail/sepsis. [2] http://www.who.int/zh/news-room/fact-sheets/detail/the-top-10-causes-of-death. [3] Goto M, Schweizer ML, Vaughan-Sarrazin MS, et al.Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003-2014[J].JAMA Intern Med, 2017, 177:1489-1497. doi: 10.1001/jamainternmed.2017.3958 [4] Morgan DJ, Dhruva SS, Wright SM, et al. Update on Medical Practices That Should Be Questioned in 2015[J]. JAMA Intern Med, 2015, 175:1960-1964. doi: 10.1001/jamainternmed.2015.5614 [5] Pham OH, McSorley SJ. Protective host immune responses to Salmonella infection[J]. Future Microbiol, 2015, 10: 101-110. doi: 10.2217/fmb.14.98 [6] Hoenigl M, Strenger V, Buzina W, et al. European Organization for the Research and Treatment of Cancer/ Mycoses Study Group (EORTC/MSG) host factors and invasive fungal infections in patients with haematological malignancies[J]. J Antimicrob Chemother, 2012, 67: 2029-2033. doi: 10.1093/jac/dks155 [7] Drinka P, Niederman MS, El-Solh AA, et al. Assessment of risk factors for multi-drug resistant organisms to guide empiric antibiotic selection in long term care: a dilemma[J]. J Am Med Dir Assoc, 2011, 12:321-325. doi: 10.1016/j.jamda.2010.06.012 [8] Aliberti S, Di Pasquale M, Zanaboni AM, et al. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia[J]. Clin Infect Dis, 2012, 54:470-478. doi: 10.1093/cid/cir840 [9] Lambke M.Local antibiograms can reduce inappropriate antibiotic prescribing[J]. Am Fam Physician, 2012, 85:948-950. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=c9549cfbf52d4119d5aac8e246d32139 [10] http://mghlabtest.partners.org/Microbiology.htm. [11] Bissonnette L, Bergeron MG. Diagnosing infections—current and anticipated technologies for point-of-care diagnostics and home-based testing[J]. Clin Microbiol Infect, 2010, 16:1044-1053. doi: 10.1111/j.1469-0691.2010.03282.x [12] Chiu CY, Bres V, Yu G, et al. Genomic Assays for Identification of Chikungunya Virus in Blood Donors, Puerto Rico, 2014[J]. Emerg Infect Dis, 2015, 21:1409-1413. doi: 10.3201/eid2108.150458 [13] Chiu CY. Viral pathogen discovery[J]. Curr Opin Microbiol, 2013, 16:468-478. doi: 10.1016/j.mib.2013.05.001 [14] https://www.cdc.gov/hai/organisms/cre/trackingcre.html. [15] https://www.hopkinsmedicine.org/amp/index.html. [16] https://www.mayoclinic.org/departments-centers/infectious-diseases/overview. -
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