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1.
1.
The increase in the use of broad-spectrum antibiotics can increase the risk of potential drug resistance of pathogens
Carbapenem antibiotics was considered to be anti- infection treatment of infection " last line of defense " , but the concern is that in addition to Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa Bacteria maintain a high resistance to carbapenem antibiotics (imipenem, meropenem), which brings severe challenges to the treatment, prevention and control of infectious diseases
2.
2.
Carbapenem antibacterial drugs have a broad antibacterial spectrum and strong antibacterial activity.
The "Guiding Principles for the Clinical Application of Antimicrobial Drugs ( 2015 Edition)" clearly stated that the clinical application indications of carbapenem antimicrobials are as follows: severe infections caused by multi-drug resistant but sensitive aerobic gram-negative bacilli; Severe patients with mixed infections of anaerobes and aerobic bacteria such as bacilli; empirical treatment of infections in patients with severe immunodeficiency whose pathogens have not yet been identified
The most commonly used carbapenem antibiotics in clinical practice at this stage are mainly imipenem - cilastatin , meropenem and ertapenem, in addition to biapenem and panipenem
3.
Despite the continuous emergence of resistant strains of carbapenem antibiotics, carbapenem antibiotics still play an important role in the treatment of infections caused by carbapenem-resistant bacteria
The main mechanism of Enterobacteriaceae bacteria showing carbapenem-resistant phenotype is mainly carbapenemase production
First of all, we need to make it clear that CRE infection leads to bloodstream infections, hospital-acquired lower respiratory tract infections, abdominal cavity infections, skin and soft tissue infections, and urinary tract infections are suitable for combined treatment
First of all, we need to make it clear that CRE infection leads to bloodstream infections, hospital-acquired lower respiratory tract infections, abdominal cavity infections, skin and soft tissue infections, and urinary tract infections are suitable for combined treatment
So, will the combined application of different types of antibiotics achieve a synergistic effect of "1+1 > 2" ? A recent systematic review showed that carbapenem combined with aminoglycosides / or combined with polymyxin B has a higher synergistic effect on CRKP , especially for strains with heterogeneous resistance to polymyxin
In addition, for pan-resistant Acinetobacter baumannii, a triple anti-infective treatment plan based on carbapenem antibiotics is still needed
Four, rational use of antibiotics
With the increase of immunodeficiency hosts and severely infected people, the risk of host exposure to carbapenem antibiotics is greatly increased.
If carbapenem antibiotics cannot be used rationally, we may face a situation where no medicine is available
.
Therefore, a series of guidelines for the application of antibiotics have been issued at the national level in order to provide an important basis for the reasonable and precise application of antibiotics
.
In recent years, with a variety of antibiotics guide consensus introduction, and achieved gratifying results
.
The resistance rate of Pseudomonas aeruginosa to carbapenem antibiotics has a decreasing trend
.
However, in the clinical real world, the precise application of antibiotics is not only limited to the choice of antibiotics, it also includes the early application of antibiotics, the choice of antibiotic infusion methods and duration, and the identification of infections
.
If carbapenem antibiotics cannot be used rationally, we may face a situation where no medicine is available
.
Therefore, a series of guidelines for the application of antibiotics have been issued at the national level in order to provide an important basis for the reasonable and precise application of antibiotics
.
In recent years, with a variety of antibiotics guide consensus introduction, and achieved gratifying results
.
The resistance rate of Pseudomonas aeruginosa to carbapenem antibiotics has a decreasing trend
.
However, in the clinical real world, the precise application of antibiotics is not only limited to the choice of antibiotics, it also includes the early application of antibiotics, the choice of antibiotic infusion methods and duration, and the identification of infections
.
Accurate Guidelines Consensus
Undoubtedly, the precise and rapid detection of etiology is still the core of the prevention, diagnosis and treatment of infectious diseases
.
At present, the most commonly used clinical pathogen detection methods are mainly traditional culture and nucleic acid-based PCR detection methods.
With the rapid development of high-throughput sequencing technology and the significant reduction in cost, the sequencing technology has gradually been applied to clinical infectious disease pathogens.
Quick check of learning
.
The continuous innovation of rapid pathogenic examination technology provides an important guarantee for the early and accurate application of antibiotics for clinical infectious diseases
.
.
At present, the most commonly used clinical pathogen detection methods are mainly traditional culture and nucleic acid-based PCR detection methods.
With the rapid development of high-throughput sequencing technology and the significant reduction in cost, the sequencing technology has gradually been applied to clinical infectious disease pathogens.
Quick check of learning
.
The continuous innovation of rapid pathogenic examination technology provides an important guarantee for the early and accurate application of antibiotics for clinical infectious diseases
.
In addition, another aspect that needs special attention in the diagnosis and treatment of infectious diseases is the host factor.
Simply put, the site of infection, antibiotic exposure, the underlying disease state (for example, whether there is immunosuppression), whether the current medication is antagonistic, and many other factors
.
Therefore, the rational application of antibiotics needs to integrate local pathogen epidemiology, microbial test results and other pathogenic characteristics, as well as infection sites, types and other host-related factors
.
In summary, carbapenem antibiotics are a " double-edged sword " .
Although their antibacterial effect is strong, excessive and unreasonable use can increase the number of resistant strains to carbapenem antibiotics
.
Simply put, the site of infection, antibiotic exposure, the underlying disease state (for example, whether there is immunosuppression), whether the current medication is antagonistic, and many other factors
.
Therefore, the rational application of antibiotics needs to integrate local pathogen epidemiology, microbial test results and other pathogenic characteristics, as well as infection sites, types and other host-related factors
.
Medical summary, the carbapenem antibiotics is a " double-edged sword " , although its strong antibacterial effect, but excessive use can make the unreasonable increase of carbapenem antibiotic resistant strains
.
Therefore, in clinical practice, we need to continuously optimize the application of carbapenem antibiotics and do a good job of pathogen resistance monitoring, so as to provide an important guarantee for the prevention, diagnosis and treatment of infectious diseases
.
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