Introduction

International guidelines have recommended for many years to start antimicrobials as early as possible in sepsis and shock. This concept has been challenged by the controversial results of experimental studies and clinical cohorts and resulted in intense debate in the literature.

This review aims to summarize the available knowledge on early antimicrobial therapy and to consider perspectives.

Areas covered

First, after a research using MEDLINE, we reviewed the studies that advocated the implementation of early antimicrobial therapy. We then discussed the drawbacks of these studies. Finally, we suggested possible explanations of the benefit and then absence of the prognostic impact of early antimicrobial therapy i.e. confounding factors, irreversibility of the inflammatory process, non-control of the source of the infection, pharmacodynamic considerations and the harmful effect of antimicrobial drugs.

Expert opinion

Sepsis is very heterogeneous. The first antimicrobial therapy should be personalized. The sickest patients should be given early antimicrobial therapy, whereas a “watch and wait process” should be preferred for less severe patients, to allow confirmation of sepsis, identification of pathogens and administration of adequate antimicrobial therapy. We propose steps to personalize the first antimicrobial therapy. New early diagnostic tools will assist the physicians in the future.

中文翻译：

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第一个小时的抗生素：有新证据吗？

介绍

多年来，国际准则建议在败血症和休克中尽早开始使用抗菌药物。这个概念已经受到实验研究和临床队列研究的争议，并在文献中引起了激烈的争论。

这篇综述旨在总结关于早期抗菌治疗的现有知识并考虑观点。

覆盖区域

首先，在使用MEDLINE进行研究后，我们回顾了提倡早期抗菌治疗实施的研究。然后，我们讨论了这些研究的弊端。最后，我们提出了可能的解释，以解释早期抗菌治疗的益处，然后缺乏预后的影响，即混杂因素，炎症过程的不可逆性，感染源的不可控制性，药效学方面的考虑以及抗菌药物的有害作用。

专家意见

脓毒症非常异质。第一种抗菌疗法应个性化。最病的患者应接受早期抗微生物治疗，而重度较轻的患者应首选“观察和等待过程”，以确认败血症，病原体鉴定和适当的抗微生物治疗。我们提出了个性化第一种抗菌疗法的步骤。新的早期诊断工具将在将来为医生提供帮助。