儿科重症感染治疗策略的再认识

在儿科临床领域，重症感染、抗生素耐药和脏器功能的发育未完善是儿科医师面对的难题，“重锤猛击”和“降阶梯治疗”策略是临床抗感染领域的重要方法，其所强调的早期、广覆盖抗生素治疗挽救了众多儿科危重症患者。与此同时，一些问题逐渐显现：是否会导致抗生素的过度使用、降阶梯的时机、对临床预后的影响等。鉴于缺乏儿科相关的临床研究结果，因此需要在儿童危重症抗感染治疗过程中注重以微生物学检测和临床药学为导向。以微生物检测结果指导更精准的抗生素选择，以避免“广覆盖”式抗生素使用及其所带来的不良反应。充分考虑儿科危重症的病理生理变化，遵循临床药学所制定的抗生素药物代谢动力学／药物效应动力学原则，以血药浓度监测为手段，合理应用抗生素。更多的随机对照试验和真实世界研究验证，将为儿科抗感染治疗提供更好、更新的进展。

Reconsideration on therapeutic strategy of critical infection of children

Serious infection,antibiotic resistance and uncompleted development of organ function are critical problems for pediatrician.The hitting hard and de-escalation are important strategies of antibiotics ap-plication for anti-infection therapy.The emphasis of early applying of broad spectrum antibiotics saved a lot pediatric critically ill patients.Meanwhile,problems gradually appeared such as the overuse of antibiotics,the start time of de-escalation therapy and the impact on the clinical prognosis of patients.Considering that pedi-atric related results of cliniac l research were absent,an anti-infce tion therapy which is guided by microbiolo-gical test and clinical pharmacy is actually needed in the treatment of critically ill patients.Appropriate antibi-otics are chosen based on pathogenic bacetri um detectni g,which avoied sth e overuse of broad spectrum antibi-otics and side effects following overuse of antibiotics.Pathological and physiological changes of critical child should also be considered completely.The pharmacokni etics/pharmacodynamics principle of antibiotics should be followed basing on blood medicinal concentration assay for rational usage of antibiotics.Finally, more randomized controlled trials and real world research trials would be needed for pediatric anti-infection therapy in the future.