Evaluating the efficacy of antimicrobial cycling programmes and patient isolation on dual resistance in hospitals
Evaluating the efficacy of antimicrobial cycling programmes and patient isolation on dual resistance in hospitals
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DOI：
10.1080/17513758.2010.488300
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发表时间：
2011-01-01
影响因子：
2.8
通讯作者：
Castillo-Chavez, Carlos
中科院分区：
文献类型：
--
作者：
Chow, Karen;Wang, Xiaohong;Castillo-Chavez, Carlos
抗药性细菌在医院造成大量感染，被认为是对公共健康的威胁。建议的一种遏制医院获得性感染耐药发展的策略是抗菌循环，即抗生素类别随着时间的推移而交替。这可以与混合方案进行比较，在混合方案中，当给予两种药物时，一半的医生会开出一种药物而不是另一种药物。建立了医院人群中抗菌药物循环的数学模型，以评估循环方案的效果，重点是减少双重耐药的出现和意义。该模型还考虑了医生依从性和隔离携带双重耐药细菌的患者的影响。模拟结果表明，医院人群中最优的抗菌药物使用方案取决于目标治疗的耐药类型；与混合方案相比，循环方案更有效地对抗双重耐药。患者隔离和对自行车计划的高度依从性也表明，大大减少了住院人口的双重耐药性。归根结底，独家使用抗菌药对抗医院感染并不能解决问题，反而会减缓似乎是一场失败的抗药性之战。我们希望这篇论文有助于引发对医院环境中复杂的耐药性问题的多个维度的讨论。
Antibiotic-resistant bacteria cause a number of infections in hospitals and are considered a threat to public health. A strategy suggested to curb the development of resistant hospital-acquired infections is antimicrobial cycling, in which antibiotic classes are alternated over time. This can be compared with a mixing programme in which, when given two drugs, half of the physicians prescribe one drug over the other. A mathematical model of antimicrobial cycling in a hospital population setting is developed to evaluate the efficacy of a cycling programme with an emphasis on reducing the emergence and significance of dual resistance. The model also considers the effects of physician compliance and isolating patients harbouring dual-resistant bacteria. Simulation results show that the optimal antimicrobial drug usage programme in hospital populations depends upon the type of resistance being targeted for treatment; a cycling programme is more effective against dual resistance compared with mixing. Patient isolation and high compliance to a cycling programme is also shown to dramatically decrease dual resistance in hospitalized populations. Ultimately, the exclusive use of antimicrobials in fighting nosocomial infection does not solve the problem but just slows down what appears to be a losing battle against drug resistance. We hope that this paper serves to instigate discussion on the many dimensions of the complex problem of drug resistance in hospital settings.