感染引起的脓毒症是危重患者中常见的死亡原因。最常见的感染部位是呼吸道,腹部,尿路感染和导管相关血流感染。早期的经验主义,以降低死亡率为目的的严重脓毒症和/或休克患者的广谱治疗可能导致抗生素过度使用,阻力和增加的成本。在众多血清生物标志物中,降钙素原(PCT)是诊断脓毒症最可靠的指标之一。限制抗生素耐药性的重要手段是抗生素管理计划,特别是在重症监护病房的危重病人和多重耐药病原体的流行。PCT指导的抗生素管理首先在西欧和亚太国家开始,以及在美国。考虑到该方法已被证明可有效减少抗生素消耗,同时改善临床结果,来自巴尔干地区的专家组决定提出自己的建议和PCT协议。在创建抗生素治疗的开始和持续时间的协议时,他们特别回顾了下呼吸道感染和败血症的文献。在协议中,它们包括疾病的严重程度,临床评估,PCT水平。由各个医学领域的杰出专家/专家就临床算法达成共识应该使临床医生能够使用PCT开始抗生素治疗并监测PCT以更早地停止抗生素。至关重要的是,PCT指导算法必须成为机构管理计划的组成部分。
Sepsis as a consequence of infection is a frequent cause of death among critically ill patients. The most common sites of infection are lover respiratory tract, abdominal, urinary tract and catheter-associated blood stream infections. Early empiric, broad-spectrum therapy in those with severe sepsis and/or shock with the aim of reducing mortality may lead to antibiotic overuse, resistance and increased costs. Among numerous serum biomarkers, procalcitonin (PCT) has proved to be one of the most reliable ones in the diagnosis of sepsis. An important means of limiting antibiotic resistance is the antibiotic stewardship program, especially in intensive care units with critically ill patients and prevalence of multiple drug-resistant pathogens. The PCT-guided antibiotic stewardship was first started in Western Europe and Asia-Pacific countries, as well as in the United States. Considering that this method has proven to be effective in reducing antibiotic consumption while improving clinical outcome, a group of experts from the Balkan region decided to make their own recommendations and PCT protocol. When creating this protocol for initiation and duration of antibiotic treatment, they especially reviewed the literature for lower respiratory tract infection and sepsis. In the protocol, they have included the severity of illness, clinical assessment, and PCT levels. Developing a
consensus on the clinical algorithm by eminent experts/specialists in various fields of medicine should enable clinicians to use PCT for initiation of antibiotic therapy and monitoring PCT to stop antibiotics earlier. It is crucial that the PCT-guided algorithm becomes an integral part of institutional stewardship program.