Impact of Ceftazidime Use on Susceptibility Patterns in the Neonatal Intensive Care Unit.
Impact of Ceftazidime Use on Susceptibility Patterns in the Neonatal Intensive Care Unit.
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头孢他啶使用对新生儿重症监护病房易感性模式的影响。
DOI：
10.1097/inf.0000000000002255
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
WelliverSr,RobertC
中科院分区：
文献类型：
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作者：
Miller,JamieL;Johnson,PeterN;White,BryanP;Neely,StephenB;Chaaban,Hala;Kassa,Netsanet;WelliverSr,RobertC
背景：头孢噻肟短缺后，新生儿重症监护病房（NICU）中头孢他啶的使用增加。这一变化的影响尚不清楚。目的是评估增加头孢他啶的使用对革兰氏阴性菌在新生儿重症监护室的易感性的影响。方法：回顾性研究的革兰氏阴性菌株确定在血液，尿液，脑脊液，气管切开术，腹腔液和胸腔积液培养从一个单中心新生儿重症监护室超过5年的时间。记录90天内发生的重复培养。根据停用头孢噻肟定义短缺前和短缺后时期。第三代和第四代头孢菌素的敏感率进行了比较期间，以及超广谱β-内酰胺酶（ESBL）大肠埃希菌和克雷伯菌species.Results的比率：分析包括666株。12例（1.8%）为90天后出现的重复分离株。短缺前期包括464株（69.7%）分离株，短缺后期包括202株（30.3%）分离株。当排除重复时，未观察到敏感率的显著差异。E.大肠埃希菌感染率为3.8% vs. 4.9%，P= 1.000。未发现ESBL阳性克雷伯菌属。一个事后分析的重复分离株表现出显着较低的敏感率为铜绿假单胞菌头孢他啶（风险比0.58; 95%CI：0.43-0.79）和头孢吡肟（风险比0.66; 95%CI：0.51-0.86）。结论：头孢他啶的使用似乎没有影响第三代和第四代头孢菌素的敏感率为大多数革兰氏阴性菌在短期的1.5年。然而，当评价重复分离株时，铜绿假单胞菌的敏感率降低。需要进行长期监测来评估真正的影响。
Background:Ceftazidime use in the neonatal intensive care unit (NICU) has increased after a cefotaxime shortage. The impact of this change is unknown. The purpose was to assess the effect of increased ceftazidime use on susceptibilities of Gram-negative organisms in the NICU.Methods:Retrospective study of Gram-negative isolates identified in blood, urine, cerebrospinal fluid, tracheostomy, abdominal fluid and pleural fluid cultures from a single-center NICU over a 5-year period. Duplicate cultures that occurred within 90 days were noted. Pre-and postshortage periods were defined based on cessation of cefotaxime. Third-and fourth-generation cephalosporin susceptibility rates were compared between periods, as well as rates of extended-spectrum beta-lactamase (ESBL) Escherichia coli and Klebsiella species.Results:Analysis included 666 isolates. Twelve (1.8%) were duplicate isolates that occurred after a 90-day period. The preshortage period included 464 (69.7%) isolates, and the postshortage included 202 (30.3%). No significant differences in susceptibility rates were noted when excluding duplicates. No difference in ESBL rates for E. coli were noted between periods (3.8% vs. 4.9%, P= 1.000). No ESBL-positive Klebsiella species were identified. A post-hoc analysis of duplicate isolates demonstrated significant lower susceptibility rates for Pseudomonas aeruginosa to ceftazidime (risk ratio 0.58; 95% CI: 0.43–0.79) and cefepime (risk ratio 0.66; 95% CI: 0.51–0.86).Conclusions:Ceftazidime use did not appear to affect susceptibility rates for third-and fourth-generation cephalosporins for most Gram-negative organisms in the short-term of 1.5 years. However, susceptibility rates for P. aeruginosa decreased when evaluating duplicate isolates. Long-term monitoring is needed to assess the true impact.