Antibiotic resistance in long-term acute care hospitals: The perfect storm
Antibiotic resistance in long-term acute care hospitals: The perfect storm
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DOI：
10.1086/507280
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发表时间：
2006-09-01
影响因子：
4.5
通讯作者：
Steinberg, James P.
中科院分区：
文献类型：
--
作者：
Gould, Carolyn V.;Rothenberg, Richard;Steinberg, James P.
objective.研究长期急性护理医院（LTACHS）的细菌抗生素耐药性和抗生素使用模式，并评估抗生素使用和其他医院级变量对抗生素耐药性流行的影响。多医院生态学研究方法。从2002年和2003年的45个LTACH中获得抗生素谱、抗生素购买数据和人口统计学变量。构建多变量回归模型，控制其他医院级变量，以评估抗生素使用对选定病原体耐药性的影响。在2003年在一个LTACH主动监测的结果是可用的。在LACH中，几种抗菌药物-微生物对的耐药中位患病率大于国家医院感染监测系统（NNIS）医疗重症监护室（ICU）的第90百分位值。在金黄色葡萄球菌分离株中，甲氧西林耐药的中位患病率为84%。在一个LTACH中超过60%的患者感染或定植有耐甲氧西林的沙门氏菌。金黄色葡萄球菌和/或万古霉素耐药肠球菌。LTACH中的抗生素消耗量与NNIS医疗ICU中的消耗量相当。在多变量logistic回归模型中，抗生素使用与抗生素耐药患病率之间唯一显著相关的是铜绿假单胞菌分离株中的碳青霉烯类和亚胺培南耐药（比值比，11.88 [ 95%置信区间，1.42- 99.13];）。Pp. 02结论从LACH患者体内回收的细菌中抗生素耐药性的流行率极高。尽管在LTACH中使用抗生素可能导致某些抗菌药物-微生物对的耐药性流行，但对于大多数此类对，其他变量（如抗菌药物耐药病原体的既往定植和水平传播）可能是更重要的决定因素。需要进一步研究LTACTs的抗生素耐药性，特别是在确定这种环境下的最佳感染控制措施方面。
objective. To examine bacterial antibiotic resistance and antibiotic use patterns in long- term acute care hospitals ( LTACHs) and to evaluate effects of antibiotic use and other hospital- level variables on the prevalence of antibiotic resistance.design. Multihospital ecologic study.methods. Antibiograms, antibiotic purchasing data, and demographic variables from 2002 and 2003 were obtained from 45 LTACHs. Multivariable regression models were constructed, controlling for other hospital- level variables, to evaluate the effects of antibiotic use on resistance for selected pathogens. Results of active surveillance in 2003 at one LTACH were available.results. Among LTACHs, median prevalences of resistance for several antimicrobial- organism pairs were greater than the 90th percentile value for National Nosocomial Infections Surveillance system ( NNIS) medical intensive care units ( ICUs). The median prevalence of methicillin resistance among Staphylococcus aureus isolates was 84%. More than 60% of patients in one LTACH were infected or colonized with methicillin- resistant S. aureus and/ or vancomycin- resistant Enterococcus at the time of admission. Antibiotic consumption in LTACHs was comparable to consumption in NNIS medical ICUs. In multivariable logistic regression modeling, the only significant association between antibiotic use and the prevalence of antibiotic resistance was for carbapenems and imipenem resistance among Pseudomonas aeruginosa isolates ( odds ratio, 11.88 [ 95% confidence interval, 1.42- 99.13];). Pp. 02conclusions. The prevalence of antibiotic resistance among bacteria recovered from patients in LTACHs is extremely high. Although antibiotic use in LTACHs likely contributes to resistance prevalence for some antimicrobial- organism pairs, for the majority of such pairs, other variables, such as prior colonization with and horizontal transmission of antimicrobial- resistant pathogens, may be more important determinants. Further research on antibiotic resistance in LTACHs is needed, particularly with respect to determining optimal infection control practices in this environment.