诊治感染性疾病应树立微生物思维模式:菌道之说

Microbiological thinking should be set up in the diagnosis and treatment of infection: the natural law of bacteria

目前,我国规范的抗感染治疗在具体实施过程中仍然存在困难。首先,对感染性疾病诊断的准确性缺乏认识,可能导致盲目的"大包围、广覆盖"的经验性抗感染治疗。其次,对微生物感染的致病规律缺乏了解。微生物侵入人体后,致机体的病理生理变化有一定规律性,且具有特异性。这种致病性差异,在一定程度上决定了抗菌药物的疗效,因而,在"宿主-微生物-抗菌药"这个铁三角中,仅考虑"微生物-抗菌药"的双向性,即使诊断正确,采用"大包围"治疗,同样可导致抗感染失败。所以,临床医师应依据微生物生存环境和致病特性的不同,即"细菌之道",去探寻感染性疾病最大可能的病原体特性以及最佳的抗感染治疗策略。

Standard anti-infective therapy has been widely accepted,but it is still difficult to implement.First,the lack of accuracy recognition of the infectious diseases may lead to the blind″big encirclement,wide coverage″inappropriate empiric anti-infective treatment.Second,we lack the understanding of the pathogenic regularity of microorganism infection.The invasion of microorganism to the human leads to certain regularity in pathophysiology,but it is also specific.The difference in pathogenicity,to some extent,determines the efficacy of antimicrobial agents.Therefore,in the iron triangle of″host-microbial-antimicrobial reagents″,only considering the bidirectional nature of″microbial-antimicrobial reagents″,even if the diagnosis is correct and taking the″big encirclement″treatment,it can also leadto the failure of anti-infection.Thus the clinicians should explore the most likely pathogens and the most effective anti-infective treatment strategies according to the different living environment and pathogenic characteristics of microbes,that is,″the law of bacteria″.