在高风险免疫抑制人群中采用前瞻性抗菌药物管理(AMS)实践:抗菌药物耐药性(AMR)时代的紧急行动呼吁。

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-09-27 eCollection Date: 2024-10-01 DOI:10.1093/jacamr/dlae145
S Agrawal, A Bapat, J Amos, E Howes, T Ashfield
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引用次数: 0

摘要

在全球范围内,包括强化化疗和骨髓移植在内的拯救生命的免疫抑制治疗使患者面临相当大的感染死亡风险。随着 AMR 和传播的不断发展,这可能会给全球患者和整个社会带来灾难。抗菌药物管理(AMS)以及对可能致命的紧急感染进行及时适当的处理至关重要。现在很明显的一点是,对血液肿瘤患者进行抗菌预防治疗可能不会给患者的生存带来益处,同时还会增加携带 AMR 的风险。随着 AMR 的不断发展和全球免疫抑制人群的不断增加,我们必须采取强有力的 AMS 措施。为消除 AMR 对免疫抑制患者的影响,我们动用了大量资源。对于中低收入国家(LMICs)来说,可能无法获得这些资源,因此 AMR 造成的影响更大。通过全面考虑患者的治疗过程,我们可以从时间和地理角度考虑患者面临的感染风险。我们提倡采用多学科团队(MDT)式的感染预先护理规划这种短期且易于实施的方法。只要使用得当,抗菌药物就能使医疗程序得以实施和存在。事实上,临床医学的未来将依赖于这种尚未实现的 "促进 "价值。所有部门都必须从整体出发,积极主动地做出努力和改变;因此,我们推动成立了行业和临床联合工作组。免疫抑制高危人群是变革的前哨,因此必须认识并实施以患者为中心的预防感染行动,我们的建议是对行动的紧急呼吁。
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Adopting prospective antimicrobial stewardship (AMS) practice in high-risk immunosuppressed groups: an urgent call to action in the era of antimicrobial resistance (AMR).

Life-saving immunosuppressive treatments including intensive chemotherapy and bone marrow transplantation expose patients to a considerable risk of death from infection globally. With evolving AMR and transmission, this could spell disaster for patients across the world and society at large. Antimicrobial stewardship (AMS) and prompt appropriate management of potentially fatal, emergent infections are essential. It is now apparent that antibacterial prophylaxis in patients with haematological cancer may not provide survival benefit while simultaneously increasing risks for AMR carriage. With evolving AMR and increasing immunosuppressed populations across the world, we must institute robust AMS practices. Significant resources are used to combat the impact of AMR on immunosuppressed patients. For lower-middle income countries (LMICs) these resources may not be available and as such the impact caused by AMR is greater. By considering the patient journey holistically we consider risk of infection presented to patients temporally and geographically. A short-term and easy to implement approach of multi-disciplinary team (MDT)-style advance care planning for infection is advocated. Antimicrobials, when used appropriately, enable healthcare procedures to occur and exist. Indeed, the very future of clinical medicine will rely on this yet to be realized value of enablement. Proactive effort and change must occur across all sectors with holism; hence our impetus for convening a joint industry and clinical working group. With at-risk immunosuppressed groups being a sentinel for change, awareness and implementation of patient-centric actions for infection are essential and our recommendations serve as an urgent call to action.

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