专注于抗菌素耐药性感染 - 我们是否错过了树林的森林和病原体的患者?
Alexander Lawandi1,2,3,4, Sameer S Kadri1,5, John H Powers6
1Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, United States.
抗菌素耐药性 (AMR) 对患者的治疗结果产生负面影响. 将研究重点从病原体转移到患者的结果可以改善公共卫生和临床研究激励措施.
科学领域:
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
- 临床研究 临床研究
背景情况:
- 抗菌素耐药性 (AMR) 是与患者不良结果相关的重大公共卫生挑战.
- 目前的AMR策略通常集中在单个病原体上,可能会忽视更广泛的患者影响.
- 大多数与感染相关的死亡发生在患有易感病原体的患者中,而不仅仅是耐药的病原体.
研究的目的:
- 倡导抗菌素耐药性研究的范式转变,从以病原体为中心的方法转向以患者为中心的方法.
- 突出强调如何专注于患者的结果可以重新定义AMR临床研究的优先事项和激励措施.
- 提出可行的策略,将以患者为中心的指标整合到AMR研究和开发中.
主要方法:
- 对有关感染死亡率和发病率的现有数据进行分析.
- 对专注于病原体和专注于患者结果的研究策略的比较评估.
- 开发一个以患者为中心的抗菌药物管理研究框架.
主要成果:
- 在18例感染相关死亡中,有17例与易感病原体有关,这挑战了对抗性菌株的单一关注.
- 专注于患者的结果可以确定干预和资源分配的高影响领域.
- 目前的研究激励措施可能无法充分反映感染对患者福祉和生存的真正负担.
结论:
- 最近对患者结果的研究,而不是仅仅对病原体的研究,对于解决感染的全部影响至关重要.
- 实施以患者为中心的方法可以优化公共卫生干预和临床研究投资.
- 提出了六个关键建议,以指导向抗菌素耐药性领域以患者为中心的研究过渡.
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