Reducing carbapenem prescribing in high-use settings: it is possible, and it is good to talk.
Reducing carbapenem prescribing in high-use settings: it is possible, and it is good to talk.
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减少高使用环境中碳青霉烯类药物的处方：这是可能的，而且值得讨论。
DOI：
10.1007/s11739-018-1959-y
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发表时间：
2018
影响因子：
4.6
通讯作者：
Fawcett NJ
中科院分区：
文献类型：
--
作者：
Fawcett NJ
减少不必要使用抗生素的重要性，特别是我们的“最后一线”药物，怎么强调都不为过。在国家和机构层面，碳青霉烯类药物的较高使用量已被证明与较高的耐药率[1]相关，而在患者层面，碳青霉烯类药物的使用与耐药感染风险[1]相关。然而，滥用这些关键抗生素的现象很普遍。改变和减少抗生素的使用已被证明是一项重大挑战，因此成功的故事是受欢迎的。在这一期中，Fortini等人证明了2015-2016年意大利一家机构碳青霉烯类药物的使用和抗生素的总体使用大幅减少。虽然这是一个涉及单个机构的相对较小的研究，但他们显示碳青霉烯类药物的使用减少了80%，令人印象深刻，在一个机构中，他们注意到高达46%的肺炎克雷伯菌分离株对碳青霉烯类药物耐药，44%的大肠杆菌分离株对第三代头孢菌素耐药。
The importance of reducing unnecessary use of antibiotics, especially our ‘last line’agents, cannot be overstated. Higher use of carbapenems at a country and institutional level has been shown to correlate with higher rates of resistance [1], and carbapenem use at a patient level is associated with risk of resistant infection [2]. Yet overuse of these crucial antibiotics is widespread. Changing, and reducing, antibiotic use has proved a major challenge, so success stories are welcome.In this issue, Fortini et al.[3] demonstrate a sizeable reduction in carbapenem use, and antibiotic use overall, in an Italian institution 2015–2016. Whilst this is a relatively small study involving a single institution, they show an impressive 80% reduction in carbapenem use, in an institution where they note up to 46% of their Klebsiella pneumoniae isolates are resistant to carbapenems, and 44% of Escherichia coli isolates resistant to third-generation cephalosporins.