2020年ESICM抗菌药物监测在成人危重症患者中的应用指南解读--抗菌药物部分

Interpretation of application guide of European Society of Intensive Care Medicine antimicrobial monitoring in adult critical patients in 2020:antimicrobial drugs

在重症监护病房(ICU)患者的抗感染治疗中,抗菌药物的正确使用一直都是一个难题。合理地使用抗菌药物有可能挽救患者生命,但使用不当又会增加二次感染和产生耐药性的风险。为了更好地解决危重症患者的抗菌药物使用问题,欧洲重症监护医学学会(ESICM)等多个机构通过相关的调查评估与讨论,于2020年联名撰写并发表了《抗菌药物监测在成人危重症患者中的应用》指南。该指南主要对常规抗菌药物进行详细分析,通过治疗药物监测(TDM)这一方法使抗菌药物剂量个体化,目的在于指导TDM常规应用于临床实践,从而提高对成人危重症患者的治疗效果;同时,该指南还对每种抗菌药物是否适用TDM提出建议。现从指南制定流程、危重症患者的药物代谢动力学/药物效应动力学(PK/PD)问题、TDM的四大基本原则等方面对该指南中TDM在抗菌药物使用的部分进行解读,为我国成人危重症患者抗菌药物的使用提供参考。

The correct use of antibiotics has always been a difficult problem in the anti-infective treatment of patients in intensive care unit(ICU).The proper use of antibiotics has the potential to save patients'lives,but improper use increases the risk of secondary infections and the development of drug resistance.In order to better solve the problem of the use of antibiotics in critically ill patients,the European Society of Intensive Care Medicine(ESICM)and other institutions jointly wrote and published the guidance of The Application of Antimicrobial Monitoring in Adult Critically Ill Patients in 2020 after relevant investigation,evaluation and discussion.This guideline mainly analyzes conventional antibiotics in detail,and individualizes the dose of antibiotics through therapeutic drug monitoring(TDM),aiming to guide the routine application of TDM in clinical practice to improve the treatment effect of critically ill patients.The guidelines also make recommendations on whether each antibiotic is appropriate for TDM.This article interprets TDM in the use of antibiotics in the guideline from the aspects of guideline formulation process,pharmacokinetics/pharmacodynamics(PK/PD)problems of critically ill patients,and the four basic principles of TDM,providing reference for the use of antibiotics in critically ill adult patients in China.