Rotation and restricted use of antibiotics in a medical intensive cave unit - Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria
Rotation and restricted use of antibiotics in a medical intensive cave unit - Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria
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DOI：
10.1164/ajrccm.162.3.9905050
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发表时间：
2000-09-01
影响因子：
24.7
通讯作者：
Cardinaud, JP
中科院分区：
文献类型：
--
作者：
Gruson, D;Hilbert, G;Cardinaud, JP
为了验证新的抗生素策略控制方案可以最大限度地减少潜在耐药微生物引起的呼吸机相关性肺炎（VAP）发生率的假设，我们对3，455例重症监护病房患者进行了为期4年的前瞻性前后研究。考虑到我们的重症监护病房（MICU）中的细菌生态学和日益增加的抗菌素耐药性，我们决定改变我们对经验性和治疗性抗生素治疗的选择，进行监督轮换，并限制使用头孢他啶和环丙沙星，这两种药物在计划变更前被广泛使用。对于所有患者，根据支气管肺泡灌洗液标本的定量培养结果（大于或等于10（4）cfu/ml）诊断VAP。我们研究了1,044例和1,022例需要机械通气（MV）超过48小时的患者，分别在术前（2年：1995-1996）和术后（2年：1997-1998）。我们观察到VAP的连续发作从MV前的231次减少到MV后的161次（p < 0.01），特别是发生在MV前7天的VAP。引起VAP的潜在耐药革兰氏阴性杆菌如铜绿假单胞菌、洋葱伯克霍尔德菌、嗜麦芽窄食单胞菌和鲍曼不动杆菌的总数从140株减少到79株。这些细菌对抗生素方案的敏感性显著增加，尤其是铜绿假单胞菌和B。洋葱。甲氧西林敏感金黄色葡萄球菌的比例从40%上升到60%。金黄色葡萄球菌负责VAR。提示新的抗生素使用策略是降低耐药菌引起的VAP发生率的有效手段。然而，需要进一步的研究来验证这些数据。
To test the hypothesis that a new program of antibiotic strategy control can minimize the incidence of ventilator-associated pneumonia (VAP) caused by potentially antibiotic-resistant microorganisms, we performed a prospective before-after study in 3,455 patients admitted to a single intensive care unit over a 4-yr period. Regarding the bacterial ecology and the increasing antimicrobial resistance in our medical intensive care unit (MICU), we decided to vary our choice of empiric and therapeutic antibiotic treatment, with a supervised rotation, and a restricted use of ceftazidime and ciprofloxacin, which were widely prescribed before this scheduled change. For all patients, VAP was diagnosed based on the results of quantitative culture of bronchoalveolar lavage specimens (greater than or equal to 10(4) cfu/ml). We studied 1,044 and 1,022 patients requiring more than 48 h of mechanical ventilation (MV), respectively, in the before-period (2 yr: 1995-1996) and the after-period (2 yr: 1997-1998). We observed a decrease from 231 consecutive episodes of VAP in the before-period to 161 episodes of VAP in the after-period (p < 0.01), particularly for VAP occurring before 7 d of MV. The total number of potentially antibiotic-resistant gram-negative bacilli responsible for VAP such as Pseudomonas aeruginosa, Burkholderia cepacia, Steno-trophomonas maltophilia, and Acinetobacter baumanii decreased from 140 to 79 isolated bacilli. The susceptibilities of these bacteria to the antibiotics regimen increased significantly, especially for P. aeruginosa and B. cepacia. The percentage of methicillin-sensitive Staphylococcus aureus increased significantly from 40% to 60% of S. aureus responsible for VAR. These results suggest that a new strategy of antibiotics use could be an efficient means to reduce the incidence of VAP caused by antibiotic-resistant bacteria. Nevertheless, further studies are needed to validate these data.