丁欣, 王小亭. 重症医学科医院感染的药物预防治疗[J]. 协和医学杂志, 2024, 15(3): 506-512. DOI: 10.12290/xhyxzz.2024-0092
引用本文: 丁欣, 王小亭. 重症医学科医院感染的药物预防治疗[J]. 协和医学杂志, 2024, 15(3): 506-512. DOI: 10.12290/xhyxzz.2024-0092
DING Xin, WANG Xiaoting. Pharmacologic Prophylaxis of Hospital Acquired Infections in the Department of Critical Care Medicine[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(3): 506-512. DOI: 10.12290/xhyxzz.2024-0092
Citation: DING Xin, WANG Xiaoting. Pharmacologic Prophylaxis of Hospital Acquired Infections in the Department of Critical Care Medicine[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(3): 506-512. DOI: 10.12290/xhyxzz.2024-0092

重症医学科医院感染的药物预防治疗

Pharmacologic Prophylaxis of Hospital Acquired Infections in the Department of Critical Care Medicine

  • 摘要: 重症患者医院感染的发生率高且预后差,药物预防可为特定人群带来获益。对于呼吸机相关性肺炎,可针对特定患者及疾病发病时间,选择全身应用或雾化吸入抗生素预防治疗;对于重症医学科侵袭性曲霉病(invasive aspergillosis,IA)的诊断需重新认识,并评估IA高危人群预防性抗真菌治疗的必要性;巨细胞病毒(cytomegalovirus,CMV)再激活在重症患者中并不鲜见,预防性抗病毒治疗可降低CMV再激活的发生率,但能否改善患者的临床结局仍待研究进一步探索。针对重症患者医院感染进行药物预防治疗时,临床医生需对目标人群、药物种类及用药方式等因素开展充分的风险-效益评估。

     

    Abstract: Hospital acquired infections in critically ill patients are characterized by high incidence and poor prognosis, but the specific population may benefit from pharmacologic prophylaxis. For patients with ventilator-associated pneumonia, prophylaxis with systemic application or nebulized inhalation of antibiotics may be considered as a choice, depending on the characteristics of the patients and the time onset of the disease. For invasive aspergillosis (IA) in the department of critical care medicine, new perception is needed for its diagnosis and the need for prophylactic antifungal therapy should be evaluated for the high-risk group of IA. Reactivation of CMV is not uncommon in the department of critical care medicine, and prophylactic antiviral treatment may reduce the incidence of reactivation, but whether it improves clinical outcomes requires further exploration. When considering pharmacologic prophylaxis, it is necessary to conduct a thorough risk-benefit assessment of the target population, the type of drugs, and the mode of administration.

     

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