ABSTRACT

Introduction

Prompt implementation of appropriate targeted antibiotic therapy representsa valuable approach in improving clinical and ecological outcome in critically septic patients. Thismultidisciplinary opinion article aims to develop evidence-based algorithms for targeted antibiotictherapy of infection-related ventilator associated complications (IVACs) caused by Enterobacterales,which are among the most common pathogens associated with these conditions.

Areas covered

A multidisciplinary team of four experts had several rounds of assessment for developingalgorithms devoted to targeted antimicrobial therapy of IVACs caused by Enterobacterales.A literature search was performed on PubMed-MEDLINE (until March 2021) to provide evidence forsupporting therapeutic choices. Quality and strength of evidence was established according toa hierarchical scale of the study design. Six different algorithms with associated recommendations concerning therapeutic choice and dosing optimization were suggested according to the susceptibilitypattern of Enterobacterales: multi-susceptible, extended-spectrum beta-lactamase (ESBL)-producing,AmpC beta-lactamase-producing, Klebsiella pneumoniae carbapenemase (KPC)-producing, OXA-48-producing, and metallo-beta-lactamase (MBL)-producing Enterobacterales.

Expert opinion

The implementation of algorithms focused on prompt revision of antibiotic regimensguided by results of conventional and rapid diagnostic methodologies, appropriate place in therapy ofnovel beta-lactams, implementation of strategies for sparing the broadest-spectrum antibiotics, and PK/PD optimization of antibiotic dosing regimens is strongly suggested.

中文翻译：

---

一种基于证据的多学科方法，专注于为重症成人患者肠杆菌引起的感染相关呼吸机相关并发症 (IVAC) 的靶向治疗创建算法

摘要

介绍

及时实施适当的靶向抗生素治疗是改善重症脓毒症患者临床和生态结果的一种有价值的方法。这篇多学科观点文章旨在开发基于证据的算法，用于针对肠杆菌引起的感染相关呼吸机相关并发症 (IVAC) 的靶向抗生素治疗， 肠杆菌是与这些疾病相关的最常见病原体之一。

涵盖的领域

一个由四位专家组成的多学科团队对开发专门针对肠杆菌引起的 IVAC 的靶向抗菌治疗的算法进行了几轮评估 。在 PubMed-MEDLINE 上进行了文献检索（直到 2021 年 3 月），以提供支持治疗选择的证据。证据的质量和强度是根据研究设计的分级规模确定的。根据肠杆菌的易感性模式，提出了六种不同的算法以及有关治疗选择和剂量优化的相关建议：多易感、产生超广谱 β-内酰胺酶 (ESBL)、产生 AmpC β-内酰胺酶、 肺炎克雷伯菌 产生碳青霉烯酶 (KPC)、产生 OXA-48 和产生金属-β-内酰胺酶 (MBL) 的 肠杆菌。

专家意见

算法的实施侧重于以常规和快速诊断方法的结果为指导的快速修订抗生素治疗方案、新型 β-内酰胺类药物治疗的适当位置、实施保留最广谱抗生素的策略以及抗生素给药方案的 PK/PD 优化。强烈建议。