Abstract：
Bloodstream infections (BSIs) in critically ill patients are associated with significant mortality. For patients with septic shock, antibiotics should be administered within the hour. Probabilistic treatment should be targeted to the most likely pathogens, considering the source and risk factors for bacterial resistance including local epidemiology. Source control is a critical component of the management. Sending blood cultures (BCs) and other specimens before antibiotic administration, without delaying them, is key to microbiological diagnosis and subsequent opportunities for antimicrobial stewardship. Molecular rapid diagnostic testing may provide faster identification of pathogens and specific resistance patterns from the initial positive BC. Results allow for antibiotic optimisation, targeting the causative pathogen with escalation or de-escalation as required. Through this clinically oriented narrative review, we provide expert commentary for empirical and targeted antibiotic choice, including a review of the evidence and recommendations for the treatments of extended-spectrum β-lactamase-producing, AmpC-hyperproducing and carbapenem-resistant Enterobacterales; carbapenem-resistant Acinetobacter baumannii; and Staphylococcus aureus. In order to improve clinical outcomes, dosing recommendations and pharmacokinetics/pharmacodynamics specific to ICU patients must be followed, alongside therapeutic drug monitoring.
摘要：
重症患者的血流感染（BSIs）与显著的死亡率相关。对于感染性休克患者，抗生素应在一小时内给药。概率治疗应针对最可能的病原体，考虑细菌耐药性的来源和危险因素，包括当地流行病学。源代码控制是管理的关键组成部分。在使用抗生素之前发送血液培养物（BCs）和其他标本，在不拖延他们的情况下，是微生物学诊断和随后的抗菌药物管理机会的关键。分子快速诊断测试可以从初始阳性BC中更快地鉴定病原体和特定抗性模式。结果允许抗生素优化，根据需要以升级或降级为目标的致病病原体。通过这次以临床为导向的叙事回顾，我们为经验和有针对性的抗生素选择提供专家评论，包括对产超广谱β-内酰胺酶治疗的证据和建议的审查，高产AmpC和耐碳青霉烯的肠杆菌；耐碳青霉烯的鲍曼不动杆菌；和金黄色葡萄球菌。为了改善临床结果，必须遵循特定于ICU患者的给药建议和药代动力学/药效学，除了治疗药物监测。
