尊敬的胡教授，晚上好！
——续上次回复。
再增加个主题，
抗生素的管理：什么样的方式可以有效降低病患抗生素的使用（FOCUS ICU OR NOT）。
就抗生素的暴露而言，目前可能有很多方法可以降低抗生素的暴露情况：比如抗生素的stewardship，比如生物感染标志物，比如电脑系统等等。
要解决这类答案，需要循证医学的证据。
比如一篇发表在柳叶刀的文章：降钙素（procalcitonin）与抗生素的暴露关系。
有些研究表明，procalcitonin为指引处理ICU中非手术病患可以降低抗生素的暴露情况。
有些则未必。那么究竟有无没有这样的效应呢？需要循证。
【例子】
The Lancet, Volume 375, Issue 9713, Pages 463 - 474, 6 February 2010
Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trialSummaryBackgroundReduced duration of antibiotic treatment might contain the emergence of multidrug-resistant bacteria in intensive care units. We aimed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting.
MethodsIn this multicentre, prospective, parallel-group, open-label trial, we used an independent, computer-generated randomisation sequence to randomly assign patients in a 1:1 ratio to procalcitonin (n=311 patients) or control (n=319) groups; investigators were masked to assignment before, but not after, randomisation. For the procalcitonin group, antibiotics were started or stopped based on predefined cut-off ranges of procalcitonin concentrations; the control group received antibiotics according to present guidelines. Drug selection and the final decision to start or stop antibiotics were at the discretion of the physician. Patients were expected to stay in the intensive care unit for more than 3 days, had suspected bacterial infections, and were aged 18 years or older. Primary endpoints were mortality at days 28 and 60 (non-inferiority analysis), and number of days without antibiotics by day 28 (superiority analysis). Analyses were by intention to treat. The margin of non-inferiority was 10%. This trial is registered with ClinicalTrials.gov, number NCT00472667.
FindingsNine patients were excluded from the study; 307 patients in the procalcitonin group and 314 in the control group were included in analyses. Mortality of patients in the procalcitonin group seemed to be non-inferior to those in the control group at day 28 (21·2% [65/307] vs 20·4% [64/314]; absolute difference 0·8%, 90% CI −4·6 to 6·2) and day 60 (30·0% [92/307] vs 26·1% [82/314]; 3·8%, −2·1 to 9·7). Patients in the procalcitonin group had significantly more days without antibiotics than did those in the control group (14·3 days [SD 9·1] vs 11·6 days [SD 8·2]; absolute difference 2·7 days, 95% CI 1·4 to 4·1, p<0·0001).
InterpretationA procalcitonin-guided strategy to treat suspected bacterial infections in non-surgical patients in intensive care units could reduce antibiotic exposure and selective pressure with no apparent adverse outcomes.
FundingAssistance Publique-Hôpitaux de Paris, France, and Brahms, Germany.
对这个干预策略我并没有完全理解，查阅了一些文献，研读中。 遇到瓶颈，故而提出疑问。
设想： 1.可以在本次年会上能增加这方面的专门知识介绍 2.是否可以增加抗生素管理，降低病患抗生素暴露方面的META专题？很希望听到临床的专业意见。
——小鱼儿
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