Antibiotics are fundamental in sepsis management; however, the optimal empirical treatment remains debated. Despite anaerobes rarely being the causative pathogen of sepsis, antibiotics targeting them are frequently used, which might lead to unintended consequences. Multiple studies have shown that depletion of commensal anaerobic gut microbes by anti-anaerobic antibiotics influences systemic immunity and is associated with increased mortality in patients with sepsis. However, this knowledge has not yet been translated into clinical practice. When considering empirical coverage of anaerobic pathogens in sepsis, most physicians advocate for a better-safe-than-sorry approach. In this Viewpoint, we argue that anti-anaerobic antibiotics could often result in being sorry rather than safe. We provide an overview of the limited necessity of anaerobic coverage and the potential detrimental effects of anaerobic depletion in sepsis. We aim to raise anaerobic awareness to reduce the unnecessary use of anti-anaerobic antibiotics in empirical sepsis treatment and improve patient outcomes.

中文翻译：

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脓毒症的经验性抗生素治疗：拯救厌氧微生物群


抗生素是脓毒症管理的基础;然而，最佳经验治疗仍存在争议。尽管厌氧菌很少是脓毒症的致病病原体，但经常使用针对厌氧菌的抗生素，这可能会导致意想不到的后果。多项研究表明，抗厌氧抗生素对共生厌氧肠道微生物的耗竭会影响全身免疫，并与脓毒症患者的死亡率增加有关。然而，这些知识尚未转化为临床实践。在考虑脓毒症中厌氧菌病原体的经验覆盖率时，大多数医生主张采取安全总比后悔更好的方法。在这个观点中，我们认为抗厌氧抗生素通常会导致遗憾而不是安全。我们概述了厌氧菌覆盖率的有限必要性以及厌氧菌耗竭对脓毒症的潜在有害影响。我们的目标是提高厌氧意识，以减少在经验性脓毒症治疗中不必要地使用抗厌氧抗生素并改善患者预后。