Key concepts in emergency surgical antibacterial treatment: your intelligible knowledge point

In the medical practice of emergency surgery, antibacterial treatment is an important means of dealing with the many infectious diseases and traumatic complications. However, a number of key concepts are essential for achieving safe, effective and reasonable antibacterial treatment. These concepts are the cornerstones that underpin the entire anti-bacterial decision-making, and a better understanding of them, both among health-care personnel and among patients and their families, will help to improve the effectiveness of treatment and ensure health.I. Antibacterial spectrumAntibacterial spectra refers to the range of bacteria that antibacterial drugs can suppress or kill. This is the primary consideration in the choice of antibacterial drugs. For example, penicillin antibiotics have a high level of antibacterial activity for gland positives, such as pneumocococcus, yellow grapes (non-resistant strains), but have a relatively weak effect on gland cactus. As algebra, antibiotics of headgills expand, their antibacterial spectroscopy expands, with a significant increase in the antibacterial activity of the third generation of headgills to the gerlanes, with some effect on, for example, copper-green-false cystasy. Knowledge of the antibacterial spectrometry helps doctors to match antibacterial drugs with the potential for infection. For example, for a patient who is diagnosed with a skin soft tissue infection, it may be more appropriate to choose a penicillin or first-generation septococcus infection if it is manifested in local red swollen fever and empirically judged to be a golden sepsis infection; in cases where the patient is a diarrhea infection, the choice of a drug with a wider antibacterial spectrum, e.g., precipitone/shubathan, may be necessary in view of the possible presence of a combination of geran cactus and anaerobic infections.II. Half-life of the drugThe half-life of the drug is the time taken to halve the concentration of the drug in the body. It determines the spacing of the drug and the duration of its effects in the body. Long-lived antibacterial drugs, such as Archicin, have high tissue concentrations and can have a half-life of 35 – 48 hours, which means that relatively long delivery intervals, such as one delivery per day, can be used, and even short-course delivery programmes, such as the 5-day treatment of archacin in some exceptional cases, are available. For a drug with a shorter half-life (approximately 1.8 hours) such as the head of the forest, a more frequent delivery, usually every 6 – 8 hours, is required in order to maintain effective blood concentration and sustain antibacterial effects. In developing anti-bacterial treatment programmes, health-care personnel must take full account of the half-life of the drug and ensure that the drug remains above the effective concentration in the body while avoiding the adverse effects of excessive drug concentrations.iii. Minimum antibacterial concentrations (MIC) and lowest fungicide concentrations (MBC)The lowest antibacterial concentration (MCC) is the lowest drug concentration that can inhibit the growth of bacteria in culture, while the lowest fungicide concentration (MBC) is the lowest drug concentration that can kill bacteria in culture. These two concepts are essential for assessing the antibacterial activity and efficacy of antibacterial drugs. In clinical practice, the MIC and MBC values of a bacteria for a specific antibacterial drug can be determined through drug sensitivity tests, thus guiding doctors in the selection of the most effective drug and in determining the appropriate dose. For example, if a bacterial substance has a low MIC value for an antibacterial drug, this indicates that the drug has a strong antibacterial activity for this bacteria, the use of a smaller dose may be sufficient for therapeutic effects; conversely, if the MIC value is higher, an additional dose or replacement of other more sensitive drugs may be required. Moreover, in the case of some serious infections, such as sepsis, knowledge of MBC values helps to determine whether microbicides are needed to completely eliminate bacteria and prevent re-emergence.IV. Joint drug indicationsNot all infections require the joint use of anti-bacterial drugs, with specific indications. When a single antibacterial drug is not effectively controlled by serious infections, such as a combination of infections (a combination of aerobic and anaerobic infections, such as a cavity infection), multiple antibacterial infections (such as co-infection of methoxysylincin and gland pneumatic fungus) and specific pathogen infections (such as tuberculosis requiring a combination of multiple antituberculosis drugs), the combination of the drug can create synergies and improve treatment effectiveness. For example, in the treatment of abdominal infections, third-generation sepsis and metrazine are commonly used in combination, for aerobic gelatins and gland positives and for anaerobics, which together cover a wide range of pathogens common to abdominal infections. However, joint use of drugs is not much better, and unjustified joint use of drugs can increase the incidence of adverse drug reactions, lead to drug interactions that affect the efficacy of treatment, increase the financial burden on patients, etc., so that the indications of joint use must be strictly followed.V. Bacteria resistanceBacteria resistance is today a serious challenge for global health care, including in emergency surgery. Bacteria produce resistance through a variety of mechanisms, such as the creation of active enzymes (e.g. β-implamide can damage β-implamide antibiotics), changing target structures (which prevent the integration of antibacterial drugs), reducing membrane penetration (which prevents drugs from entering the cell). The chronic and irrational use of antibacterial drugs, such as abuse, irregular drug treatment, etc., is the main cause of bacterial resistance. In emergency surgery, there is a greater risk of inappropriate use of antibacterial drugs due to, inter alia, the urgency of the situation and the complexity of the origin of the patients. For example, the overuse of a wide spectrum, high-level antibacterial drugs may result in the screening of drug-resistant strains that not only make the present treatment difficult, but also increase the risk of transmission in the hospital environment or in the community, affecting subsequent treatment of other patients. Therefore, the rational use of antibacterial drugs, enhanced antibacterial surveillance and the promotion of precision medical care to reduce unnecessary exposure to antibacterial drugs are key strategies for dealing with bacterial resistance.Pharmacokinetics and Drug Effects Dynamics (PK/PD)While pharmacokinetics (PK) focuses on the absorption, distribution, metabolic and excretion processes of the drug in the body, pharmacological effects of the drug on the organism and the mechanisms for its functioning are the subject of a combination of PK/PD theories that are important guidance for optimizing antibacterial treatment programmes. Based on PK/PD characteristics, antibacterial drugs can be classified as concentration and time dependence. The antibacterial activity of drugs with concentrations of dependence (e.g. amino-cluene, quinone) is mainly related to the peak concentrations of the drug, which can enhance the fungicide effect, so that these drugs can be administered at a larger dose and with a smaller number of times; the antibacterial effects of time-dependent drugs (e.g. β-nimamine) are related to the time when the drug is higher than the MIC, typically requiring multiple doses to maintain blood concentrations above the MIC for a sufficient period of time, usually requiring a blood dose of 40 – 60 per cent of the time between drugs. Knowledge of the PK/PD characteristics of antibacterial drugs helps doctors to develop individualized delivery programmes based on the characteristics of different drugs, improves the effectiveness of antibacterial treatment and reduces adverse effects.Antibacterial treatment in emergency surgery is a complex and rigorous process, and these key concepts are interlinked and interacting. It is only through a deep understanding of these concepts and their skilled application that health-care personnel can make scientifically sound decisions on antibacterial treatment in the face of various emergency infections, and that patients and their families have some knowledge of these concepts and are able to better understand treatment programmes, cooperate with medical work and work together to combat infectious diseases and ensure health.