Among a set of other types of treatment applied in intensive care units, the special role belongs to antibacterial therapy. The multiple variability of microorganisms forces to look for more and more adequate answers to a microbic invasion. Antibacterial therapy in intensive care unit can be applied as independent and even main type of treatment, for example, at infections, and can be also present at structure of complex therapy of this or that pathology and also be used for a perioperatsionny antibiotikoprofilaktika.
Antibacterial therapy should not be used uncontrolledly and without indications as in this case the risk of distribution of resistance of microorganisms even to the most strong antibacterial drugs is very high. The problem of increase of resistance of microorganisms has now global character while new antibacterial drugs are developed with essential lateness. Therefore rational approach to each patient and purpose of antibacterial drugs only is extremely important when they certainly are shown.
It should be noted that you should not use a so-called preventive antibioticotherapia, except for a perioperatsionny antibiotikoprofilaktika. Long preventive prescription of antibiotics does not reduce quantity of infections, however promotes colonization of an organism of the patient polyresistant microflora.
Besides, it is necessary to give preference to topical treatment of superficial infections. Often such infections as decubituses, trophic ulcers, a catheter - the associated cystitis and so on do not demand a system antibioticotherapia, praising on local therapy.
When choosing antibacterial drug the great value belongs to microbiological control which includes not only studying directly of the causative agent of this or that disease, but also determination of microbiological climate of intensive care unit in general. When determining the causative agent of pathology rules of an intake of material for a bacteriological research have to be followed, they can differ depending on a type of the studied material. Recently considerable attention is paid to development of systems for express diagnostics which allows to learn quickly the activator and its sensitivity to antibacterial drugs and also to reduce waiting time of result of the analysis. Optimum, if the bacteriological laboratory can quickly inform the intensivist on results of a research. That is of great importance, the hospital or extra hospital strain caused infectious process as approaches to antibacterial therapy in these cases essentially different.
The choice of concrete antibacterial drug is carried out as an empirical way, and after studying of result of bacteriological crops. As a rule, after obtaining results of the laboratory analysis carry out therapy correction if necessary. The drug choice empirically is carried out on the basis of the recommendations about treatment of this or that pathology, experience of concrete medical institution and its microbiological profile. Sampling for carrying out a microbiological research is made not once, and time in 3–4 days. At the same time it is necessary to remember that the data on sensitivity received in vitro can not correspond to clinic. Laboratory tests do not consider interaction of antibacterial drugs, sometimes use the concentration unattainable in clinical conditions (Vancomycinum) and also often are late or samples for them were taken with violation of the rules of a fence. The clinic is the only final criterion of efficiency of antibacterial therapy.
Irrational purpose of antibacterial drugs at an expected, but undocumented infection, unfairly long courses of antibacterial therapy, incorrect doses and the modes of administration of antibacterial agents lead to emergence of resistant strains of activators. As a result of all this, the absolute majority of the activators which are allocated at patients of intensive care units have polyresistance. In this regard the greatest danger is constituted by such microorganisms as Acinetobacter spp., P. aeruginosa, K. pneumoniae. At allocation of a pan-resistant strain the combination of antibacterial drugs is appointed on the basis of clinical recommendations. Monitoring of the clinical response to antibiotic treatment (pro-calcitonin, SRB, number of leukocytes) is obligatory and monitoring of clinical data at a combination therapy of a pan-resistant strain when the activator is steady against each drug of a combination separately is especially important and the clinical picture is the only criterion of efficiency of treatment.