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多重耐药性脓毒症:一项严峻的医疗保健挑战。

Multidrug-Resistant Sepsis: A Critical Healthcare Challenge.

作者信息

Kumar Nishitha R, Balraj Tejashree A, Kempegowda Swetha N, Prashant Akila

机构信息

Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India.

Department of Microbiology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India.

出版信息

Antibiotics (Basel). 2024 Jan 4;13(1):46. doi: 10.3390/antibiotics13010046.

Abstract

Sepsis globally accounts for an alarming annual toll of 48.9 million cases, resulting in 11 million deaths, and inflicts an economic burden of approximately USD 38 billion on the United States healthcare system. The rise of multidrug-resistant organisms (MDROs) has elevated the urgency surrounding the management of multidrug-resistant (MDR) sepsis, evolving into a critical global health concern. This review aims to provide a comprehensive overview of the current epidemiology of (MDR) sepsis and its associated healthcare challenges, particularly in critically ill hospitalized patients. Highlighted findings demonstrated the complex nature of (MDR) sepsis pathophysiology and the resulting immune responses, which significantly hinder sepsis treatment. Studies also revealed that aging, antibiotic overuse or abuse, inadequate empiric antibiotic therapy, and underlying comorbidities contribute significantly to recurrent sepsis, thereby leading to septic shock, multi-organ failure, and ultimately immune paralysis, which all contribute to high mortality rates among sepsis patients. Moreover, studies confirmed a correlation between elevated readmission rates and an increased risk of cognitive and organ dysfunction among sepsis patients, amplifying hospital-associated costs. To mitigate the impact of sepsis burden, researchers have directed their efforts towards innovative diagnostic methods like point-of-care testing (POCT) devices for rapid, accurate, and particularly bedside detection of sepsis; however, these methods are currently limited to detecting only a few resistance biomarkers, thus warranting further exploration. Numerous interventions have also been introduced to treat MDR sepsis, including combination therapy with antibiotics from two different classes and precision therapy, which involves personalized treatment strategies tailored to individual needs. Finally, addressing MDR-associated healthcare challenges at regional levels based on local pathogen resistance patterns emerges as a critical strategy for effective sepsis treatment and minimizing adverse effects.

摘要

全球范围内,脓毒症每年导致4890万例病例,令人震惊,造成1100万人死亡,并给美国医疗系统带来约380亿美元的经济负担。多重耐药菌(MDROs)的出现增加了应对多重耐药(MDR)脓毒症管理的紧迫性,这已演变成一个关键的全球健康问题。本综述旨在全面概述当前MDR脓毒症的流行病学及其相关的医疗挑战,特别是在重症住院患者中。突出的研究结果表明了MDR脓毒症病理生理学及其引发的免疫反应的复杂性,这严重阻碍了脓毒症的治疗。研究还表明,衰老、抗生素过度使用或滥用、经验性抗生素治疗不足以及潜在的合并症是导致脓毒症复发的重要因素,进而导致感染性休克、多器官功能衰竭,最终导致免疫麻痹,所有这些都导致脓毒症患者的高死亡率。此外,研究证实脓毒症患者再入院率升高与认知和器官功能障碍风险增加之间存在关联,从而增加了医院相关成本。为了减轻脓毒症负担的影响,研究人员致力于创新诊断方法,如用于快速、准确且特别是在床边检测脓毒症的即时检测(POCT)设备;然而,这些方法目前仅限于检测少数耐药生物标志物,因此有待进一步探索。还引入了多种干预措施来治疗MDR脓毒症,包括来自两个不同类别的抗生素联合治疗和精准治疗,精准治疗涉及根据个体需求定制的个性化治疗策略。最后,根据当地病原体耐药模式在区域层面应对与MDR相关的医疗挑战,成为有效治疗脓毒症和尽量减少不良反应的关键策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b73a/10812490/f94171615d0d/antibiotics-13-00046-g001.jpg

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