摘要
目的研究限制第三代头孢菌素的使用对ICU医院感染细菌耐药性的影响。方法将2008年1月-2009年12月入住ICU的所有可疑或确诊为革兰阴性杆菌感染的患者纳入研究,研究分为两阶段,第一阶段(2008年1-12月)所有符合条件的患者不限制应用第三代头孢菌素的治疗,第二阶段(2009年1-12月)限制使用第三代头孢菌素,尽可能选择哌拉西林/他唑巴坦进行治疗,两阶段碳青霉烯类和氟喹诺酮类抗菌药物使用不受限制;比较两阶段细菌耐药性的变化,了解限制使用第三代头孢菌素对医院感染细菌耐药性的影响。结果第二阶段革兰阴性杆菌对第三代头孢菌素耐药性明显降低,其中大肠埃希菌对头孢他啶、头孢哌酮、头孢噻肟、头孢曲松的耐药率分别由第一阶段的69.2%、76.9%、90.2%、91.3%降至第二阶段的49.6%、61.6%、69.3%、79.2%(P<0.05);耐甲氧西林金黄色葡萄球菌检出率由93.1%降至80.0%(P=0.043)。结论在ICU限制第三代头孢菌素的使用能降低革兰阴性杆菌的耐药性,同时能降低MRSA的检出率。
OBJECTIVE To investigate the influence on bacteria resistance of restricted third-generation cephalosporin use on patients with nosocomial infections in intensive care unit. METHODS From Jan 2008 to Dec 2009,a study was performed in all patients admitted to ICU who were confirmed or suspected bacterial infections.The study was divided into two phases.During the first phase（from Jan2008 to Dec2008）,all suitable patients were treated without any limitation of third-generation cephalosporin use.During the second phase（from Jan 2009 to Dec 2009）,third-generation cephalosporin use was restricted,all the patients were treated mainly with piperacillin-tazobactam.But antibiotic such as carbopenems and Fluoroquinolone was not restricted during the two phases.The difference of bacterial drug resistance between the first phase and the second phase was compared.At the same time,to seek for the effect of antibiotic rotation on drug resistance of hospital bacterial in ICU. RESULTS There was a significant decrease about the resistance of Gram-negative bacilli to third-generation cephalosporins,among which the drug resistance rates of Escherichia coli ceftazidime,cefoperazone,cefotaxime and ceftriaxone were decreased from 69.2%,76.9%,90.2% and 91.3% in first phase to 49.6%,61.6%,69.3% and 79.2% in second phase,respectively（P0.05）;at the same time,the detection rates of methicillin-resistant Staphylococcus aureus（MRSA） decreased from 93.1% to80%（P=0.043）. CONCLUSION In intensive care unit,the tactics of antibiotic restriction use through third-generation cephalosporin can decrease both drug resistance of Gram-negative bacilli to third-generation cephalosporin and the detected rate of methicillin-resistant S.aureus.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2011年第23期5029-5031,共3页
Chinese Journal of Nosocomiology
基金
江苏省"333高层次人才培养工程"基金资助(2007-58)
关键词
耐药性
第三代头孢菌素
限制使用
重症监护病房
Drug resistance
Third-generation cephalosporins
Restriction
Intensive care unit
