Drugs of last resort? The use of polymyxins and tigecycline at US Veterans Affairs medical centers, 2005-2010.
Drugs of last resort? The use of polymyxins and tigecycline at US Veterans Affairs medical centers, 2005-2010.
复制标题
最后手段的药物？ 2005 - 2010年在美国退伍军人事务中心使用多粘素和替克赛。
DOI：
10.1371/journal.pone.0036649
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Samore M
中科院分区：
文献类型：
--
作者：
Huttner B;Jones M;Rubin MA;Neuhauser MM;Gundlapalli A;Samore M
耐多药（MDR）和耐碳青霉烯（CR）革兰氏阴性病原体在地球仪中日益流行。多粘菌素和替加环素是少数几种可用于治疗这些细菌感染的抗生素，但对其使用频率知之甚少。因此，我们的目的是估计这两种药物在退伍军人事务部医疗中心（VAMCs）的胃肠外使用，并描述与其管理相关的病原体。为此，我们回顾性分析了2005年10月至2010年9月期间127例急性VAMC中多粘菌素和替加环素胃肠外给药的条形码药物给药数据。总体而言，多粘菌素和替加环素的使用相对较低，分别为0.8天治疗（DOT）/1000患者日（PD）和1.6 DOT/1000 PD。各设施的使用情况差异很大，但在研究期间总体上有所增加。八个设施占所有多粘菌素使用量的四分之三。替加环素使用的相同统计量为26例VAMC。在747例与多粘菌素使用相关的住院治疗中，有1，081例MDR或CR分离株（1.4/住院治疗）。替加环素组的这些数量略低：500例住院治疗中有671例MDR或CR分离株（1.3/住院治疗）（p = 0.06）。 在研究期间，还观察到两种抗生素与每1000 PD的CR和MDR革兰氏阴性分离株之间的生态相关性（Pearson相关系数r = 0.55多粘菌素，r = 0.19替加环素）。 总之，虽然多粘菌素和替加环素的使用在大多数VAMC中较低，但在研究期间有所增加。特别是多粘菌素的使用与MDR革兰氏阴性病原体的存在相关，并且可能在未来用作监测措施。
Multidrug-resistant (MDR) and carbapenem-resistant (CR) Gram-negative pathogens are becoming increasingly prevalent around the globe. Polymyxins and tigecycline are among the few antibiotics available to treat infections with these bacteria but little is known about the frequency of their use. We therefore aimed to estimate the parenteral use of these two drugs in Veterans Affairs medical centers (VAMCs) and to describe the pathogens associated with their administration. For this purpose we retrospectively analyzed barcode medication administration data of parenteral administrations of polymyxins and tigecycline in 127 acute-care VAMCs between October 2005 and September 2010. Overall, polymyxin and tigecycline use were relatively low at 0.8 days of therapy (DOT)/1000 patient days (PD) and 1.6 DOT/1000PD, respectively. Use varied widely across facilities, but increased overall during the study period. Eight facilities accounted for three-quarters of all polymyxin use. The same statistic for tigecycline use was twenty-six VAMCs. There were 1,081 MDR or CR isolates during 747 hospitalizations associated with polymyxin use (1.4/hospitalization). For tigecycline these number were slightly lower: 671 MDR or CR isolates during 500 hospitalizations (1.3/hospitalization) (p = 0.06). An ecological correlation between the two antibiotics and combined CR and MDR Gram-negative isolates per 1000PD during the study period was also observed (Pearson’s correlation coefficient r = 0.55 polymyxin, r = 0.19 tigecycline). In summary, while polymyxin and tigecycline use is low in most VAMCs, there has been an increase over the study period. Polymyxin use in particular is associated with the presence of MDR Gram-negative pathogens and may be useful as a surveillance measure in the future.
登录
查看更多内容
影响因子：
5.2
作者：
Hombach, Michael;Bloemberg, Guido V.;Boettger, Erik C.
通讯作者：
Boettger, Erik C.
影响因子：
14.2
作者：
Magiorakos, A. -P.;Srinivasan, A.;Monnet, D. L.
通讯作者：
Monnet, D. L.
影响因子：
4.9
作者：
Marchaim, Dror;Chopra, Teena;Kaye, Keith S.
通讯作者：
Kaye, Keith S.
影响因子：
4.1
作者：
Lim LM;Ly N;Anderson D;Yang JC;Macander L;Jarkowski A 3rd;Forrest A;Bulitta JB;Tsuji BT
通讯作者：
Tsuji BT
影响因子：
16.6
作者：
Nikaido H
通讯作者：
Nikaido H