Antimicrobial resistance in hospital organisms and its relation to antibiotic use.
Antimicrobial resistance in hospital organisms and its relation to antibiotic use.
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DOI：
10.1093/clinids/5.6.1033
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发表时间：
1983-11
期刊：
影响因子：
--
通讯作者：
J. Mcgowan
中科院分区：
文献类型：
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作者：
J. Mcgowan
引起医院感染的微生物通常对抗菌剂具有抗药性。对其原因的研究因术语定义困难、选择偏差、研究方法产生的假象以及未能控制混杂变量而受到阻碍。导致医院内耐药微生物流行率增加的主要因素是引起医院感染的微生物的变化（部分原因是医院人群特征以及患者护理中使用的程序和仪器的变化）、导致社区获得性感染的细菌耐药性流行率的增加以及抗菌药物的使用。抗生素使用与医院微生物耐药性之间的因果关系得到了几个人群中一致关联和并发变化、剂量反应模式的存在以及解释这种关系的合理生物学模型的存在的支持。对医院耐药细菌出现的主要影响包括治疗个体的抗菌作用、细菌之间耐药性转移的机制以及细菌或其耐药因素在医院内的传播途径。屏障隔离技术可以帮助控制医院内的耐药细菌。然而，几乎所有报告都认为，谨慎、有区别地使用抗菌药物仍然是最大限度减少这一问题的关键。必须更有效地向处方者传达这一需求。
Organisms causing nosocomial infection are frequently resistant to antimicrobial agents. Studies of the reasons for this have been hindered by difficulties in defining terms, by selection biases, by artifacts produced by study methods, and by failure to control for confounding variables. Major factors leading to increased prevalence of resistant organisms in hospitals are changes in organisms causing nosocomial infection (due in part to changes in characteristics of hospital populations and in procedures and instruments used in patient care), increasing prevalence of resistance in bacteria causing community-acquired infection, and use of antimicrobial agents. A causal relationship between antibiotic usage and resistance of hospital organisms is supported by consistent association and concurrent variation in several populations, presence of a dose-response pattern, and existence of a reasonable biologic model to explain the relationship. Major influences on emergence of resistant hospital bacteria include antimicrobial effects in treated individuals, mechanisms for transfer of resistance between bacteria, and routes of transmission within the hospital for bacteria or their resistance factors. Barrier isolation techniques can help control resistant hospital bacteria. However, virtually all reports agree that careful, discriminating use of antimicrobial agents remains the keystone for minimizing this problem. This need must be communicated more effectively to prescribers.