Study on early-effect prediction indicators for antibiotic treatment for patients with acute internal illness

Summary: The critical condition of patients with acute internal care is such that early and accurate prediction of the efficacy of antibiotic treatment is essential to optimize treatment programmes and improve patient prognosis. This paper examines a wide range of indicators that can be used to predict the early effects of antibiotic treatment for patients with acutely acquired infections in emergency care, including serobiology markers, microbiology indicators, genetic testing techniques, and clinical symptoms and signs. It analyses the prognosis, advantages and limitations of the indicators. The aim is to provide a comprehensive frame of reference for clinicians to determine the effectiveness of antibiotic treatment at an early stage and to adapt treatment strategies in a timely manner in order to improve the success and quality of care for patients with acutely ill infections in emergency settings.IntroductionSIRS, which is often associated with patients with acute internal illness in emergency cases, can rapidly advance to multi-organ functional impairment syndrome (MODS), with a high rate of death. Antibiotic treatment is its key treatment, but there are many challenges in the treatment process, such as whether the choice of antibiotics is appropriate and whether treatment programmes need to be adapted. Early recognition of the effectiveness of antibiotics treatment can improve patient prognosis by avoiding the continued use of non-effective antibiotics, reducing the risk of bacterial resistance, and changing treatment programmes in a timely manner. The search for reliable early-effect prediction indicators is therefore of major clinical importance.II. Serobiology markers1. Serum calcium reduction (PCT)- PCT is a precursor to calcium reduction and contains extremely low levels of serum in normal physiological conditions. When bacterial infections occur in the organism, especially in the case of acute systemic diseases, the level of the PCT can increase significantly, and their increase is related to the severity and prognosis of the infection. In the course of antibiotics treatment, dynamic changes in the PCT level can be used as an indicator of efficacy prediction. If antibiotic treatment is effective, PCT usually begins to decline in 1-2 days, the speed and extent of which is closely related to the control of infection. For example, a study of patients with acute pneumonia in emergency care found that after treatment, PCT rapidly declined to the normal range, with marked improvements in clinical symptoms, shorter hospitalization periods and lower rates of death; and that PCTs that continue to have high levels or slow declines tend to point to ineffective antibiotic treatment and may need to adjust treatment programmes, such as replacing antibiotics or increasing doses.- However, PCT has some limitations. Certain non-infective factors, such as severe trauma, surgery, self-immunological diseases, may also lead to an increase in the PCT, which may interfere with the diagnosis of infection and the assessment of the efficacy of antibiotics. In addition, the increase in the PCT may vary in the case of different pathogens, and in the case of local or mild infections, the increase in the PCT may not be significant and its diagnostic and prognosis value is relatively limited.2. C Reacting Protein (CRP)- CRP is an acute and counterproductive protein that can rise rapidly after infection. CRP levels are associated with the inflammation level of the infection among patients with acute internal illness in emergency care. After antibiotic treatment, if CRPs decline, the inflammation response is controlled and the treatment is effective. For example, in the case of patients with abdominal infections, the level of CRP for effective treatment has decreased significantly within 3-5 days, while the CRP for ineffective treatment continues to be high or further up. CRP Test methods are simple, fast and widely applied in clinical settings and can serve as one of the indicators for a preliminary diagnosis of the efficacy of antibiotics.CRP lacks specificity, however, not only in cases of bacterial infection, but also in cases of multiple diseases such as viral infections, cardiovascular diseases and malignant neoplasms. Therefore, there may be miscalculation of antibiotic treatments by relying on CRPs alone and requiring a combination of other indicators.Microbiology indicators1. Bacteria cultivation and drug sensitivity- Traditional bacterial development and drug-sensitization tests are an important basis for guiding antibiotic treatment. To the extent possible, appropriate specimens are collected for bacterial development and for drug-sensitization testing prior to the initiation of antibiotic treatment for patients with acute internal illness. Patients are more likely to be effective in the treatment of antibiotics if they are available at an early stage of treatment and the initial antibiotics are found to be sensitive to pathogens. On the other hand, if the pharmacological evidence indicates resistance to the antibiotics used, it suggests a need to replace sensitive antibiotics in a timely manner. For example, in cases of blood flow infection, the timely adjustment of antibiotic treatment programmes to drug-sensitive results can significantly improve the survival of patients.However, the time lag in bacterial development and drug-sensitive testing, which generally takes 2 – 3 days or even longer to produce results, is a clear deficiency for patients with acutely ill infections who require early diagnosis and adjustment of treatment. Furthermore, some patients may have had negative developmental outcomes as a result of the earlier use of antibiotics, affecting the accuracy and timeliness of their efficacy predictions.2. Bleeding positive time (TTP)- TTP means the time between the blood sample collection and the blood culturer when bacteria are detected to grow and light. TTP is associated with the severity and prognosis of the infection among patients with severe infections. Shorter TTPs tend to point to the strong virulence of pathogens and the high volume of bacteria, which may lead to poor prognosis. At the same time, during antibiotics treatment, TTP can also be used as an indicator of efficacy prediction. If antibiotic treatment is effective, the BB positive period may be prolonged, as effective antibiotics inhibit bacterial growth and reproduction. For example, in cases of severe golden sepsis, after effective antibiotic treatment, follow-up of blood culture TTP is significantly longer than at first, suggesting that treatment is effective; if there is no significant change or even a reduction in TTP, it may indicate that antibiotic treatment is not effective in controlling infection and that treatment programmes need to be reassessed.However, the accuracy of TTP is influenced by a number of factors, such as the amount of blood samples collected, the time taken, the conditions in which they are produced, and the different growth properties of different pathogens, which also lead to greater differences in TTP, which in part limits its wide application.Genetic testing techniques1. Genetic testing of pathogen resistance- Rapid detection of pathogen resistant genes is possible with the development of molecular biology techniques. For example, in the case of methylenedioxysilin-yellow grapes (MRSA), resistance can be determined by testing mecA genes. The early detection of the drug-resistant genes of pathogens in cases of acute internal disease can predict the effectiveness of antibiotics before the results are produced. If pathogens are detected carrying specific resistant genes, and the first antibiotics used are the drugs for that resistance mechanism, then they need to be replaced in a timely manner. For example, in some communities where pneumococcus is available, the erm gene that carries resistance to Great Ring esters should be considered for adaptation to other sensitive drugs if initial empirical use of Great Ring esters is used, which helps improve the accuracy of early treatment.However, the current prevalence of genetic testing is not high enough in the clinical field, the cost of testing is relatively high, and the testing of some new drug-resistant genes may be difficult, and methods and equipment for testing need to be further refined and optimized in order to increase the value of their application in the prediction of the antibiotic effects of patients with acute internal diseases.2. Host genetic multi-state testing- Certain genetic heterogeneity of the host may affect its susceptibility to infection and its response to antibiotics. For example, cytochrome P450 is associated with the metabolism of antibiotics in some of the genetic polymorphisms in the family. If a patient has a specific genetic polymorphosis, it can cause metabolic abnormalities in the antibiotics in the body, affecting their blood concentration and antibacterial effects. By testing the host ‘ s genetic polymorphology, it is possible to predict the patient ‘ s reaction to antibiotics and to provide a basis for individualized treatment. However, the host’s multi-morphological testing involves complex genetic knowledge and technology, and the current application in emergency clinical practice is still at an exploratory stage, and more research is needed to clarify its exact relationship with antibiotics and how it can be translated into practical clinical application strategies.V. Clinical symptoms and signs1. Temperature change- Body temperature is one of the key clinical indicators reflecting infection control. After treatment with antibiotics for patients with acute internal illness in emergency cases, if body temperature is gradually restored, the treatment may be effective. For example, in cases of severe urin system infections, with effective antibiotics treatment, fever symptoms usually begin to abate within 2 – 3 days and the body temperature is gradually reduced to normal. Persistent fever or repeated temperature fluctuations often indicate that the infection is not effectively controlled and may require further examination and adjustment of treatment programmes, such as screening for failure to clear the infection stoves and incomplete coverage of antibiotics.However, body temperature is affected by a number of factors, such as the patient ‘ s basic illness and the use of deheating drugs. Some patients may suffer from poor immune functions, and even if the infection is not effectively controlled, the body temperature may not rise or be low-heat; and some patients, using medicines such as sugar-coated hormones, do not accurately reflect the true state of the infection, which requires a combination of other symptoms and indicators to be judged.Hemodynamic indicators- In cases of serious infections, the stability of blood flow mechanics is closely linked to the prognosis. Common hemodynamic indicators such as blood pressure, heart rate, and central intravenous pressure (CVP) can also be used as therapeutic prognosis indicators during antibiotics treatment. If antibiotic treatment is effective, as the infection is controlled, the patient ‘ s blood pressure stabilizes, the heart rate slows, and CVP returns to normal. For example, in cases of infectious shock, with effective liquid resuscitation and antibiotic treatment, the average arterial pressure of the patient gradually rises to normal levels, the heart rate declines to near normal, suggesting that the infection is controlled and treatment is effective. Conversely, in the event of continued instability in blood flow mechanics indicators, it is possible to point to the failure of antibiotic treatment to effectively control infection and to the need to strengthen or adjust antiinfection treatment strategies, such as the joint use of vascular active drugs and the further optimization of antibiotic programmes.However, changes in blood flow mechanics indicators may also be disrupted by other factors, such as patients ‘ cardiovascular underlying diseases, liquid management strategies, etc. Therefore, in assessing the efficacy of antibiotics, a comprehensive analysis of the change in blood flow mechanics indicators is needed, taking into account the specific circumstances of the patient.Comprehensive assessment and outlookEarly prognosis of antibiotic treatment for patients with acute internal illness requires a combination of multiple indicators. Single indicators often have limitations and do not accurately and comprehensively reflect treatment outcomes. For example, while the PCT has a better indicative effect on bacterial infections, there are special circumstances in which a pseudo-positive or pseudo-negative nature occurs; bacterial growth and drug-sensitive results are accurate and time-consuming. The clinicians should therefore conduct a comprehensive assessment in conjunction with a wide range of information, such as serobiology markers, microbiology indicators, genetic testing techniques and clinical symptoms and signs.In the future, as technology progresses, it is expected that more rapid, accurate, accessible and cost-effective early treatment indicators or testing methods will be developed. For example, new immediate testing (POCT) techniques can rapidly detect multiple indicators by bedside, including pathogen antigens, drug-resistant genes, etc., which can significantly reduce detection time and provide a more timely basis for early adjustment of antibiotic treatment programmes. At the same time, the application of big data and artificial intelligence technologies will also open up new opportunities for the prediction of the efficacy of antibiotics, which, through the analysis and excavation of a large number of clinical data, will lead to the development of more accurate predictive models that will improve the accuracy and reliability of predictions, thus further improving the treatment effectiveness and prognosis of patients with acute internal illness in emergency cases.In the light of the above, the in-depth study and exploration of early-effect prediction indicators for antibiotic treatment for patients with acute internal illness in emergency cases is of major clinical value, which contributes to improving the quality of emergency medical care, reducing the rate of death and disability among patients with severe infections and providing greater protection for their life and health.