Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991-2003 at a university hospital in Taiwan.
Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991-2003 at a university hospital in Taiwan.
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DOI：
10.1016/j.ijantimicag.2005.08.016
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发表时间：
2005-12
影响因子：
10.8
通讯作者：
Luh KT
中科院分区：
文献类型：
--
作者：
Hsueh PR;Chen WH;Luh KT
本研究旨在评估台湾一所大学医院的抗菌药物耐药性与抗菌药物使用之间的关系。大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、粘质沙雷菌、变形杆菌属、铜绿假单胞菌，不动杆菌属，嗜麦芽窄食单胞菌和其他非发酵革兰氏阴性杆菌引起医院感染进行了评价。年病人日和年消耗量数据（每1000患者-天的限定日剂量（DDD））（头孢噻肟、头孢曲松、头孢他啶、氟氧头孢、头孢吡肟和头孢匹罗），β-内酰胺-β-内酰胺酶抑制剂复方制剂（替卡西林/克拉维酸和哌拉西林/他唑巴坦）、碳青霉烯类（亚胺培南和美罗培南），氨基糖苷类（阿米卡星、庆大霉素和妥布霉素），分析了1991 ~ 2003年氟喹诺酮类药物（环丙沙星（口服和注射用）及口服左氧氟沙星和阿托沙星）的临床应用情况。从1991年到2003年，这些细菌中的几种引起所有医院感染或医院血流感染的发病率呈上升趋势。2002年，该院的年病人日数从1991年的360210增加到672676（线性回归分析，P < 0.05），但2003年由于台湾严重急性呼吸综合征的流行而略有下降（629168）。耐头孢噻肟或耐环丙沙星的E.大肠埃希菌和美罗培南耐药铜绿假单胞菌与超广谱头孢菌素、β-内酰胺酶抑制剂组合、碳青霉烯类、氟喹诺酮类和氨基糖苷类的消耗量增加显著相关（对于环丙沙星耐药大肠埃希菌）。大肠杆菌和美罗培南耐药铜绿假单胞菌）（皮尔逊相关系数，r > 0.72（或<-0.72）和P值< 0.05）。增加耐环丙沙星的K.肺炎和美罗培南耐药不动杆菌属。与超广谱头孢菌素类抗生素的使用增加显著相关，但与其他四类抗生素无关。这项在医院进行的13年研究表明，抗菌药物的使用发生了重大变化，这可能影响了医院某些革兰氏阴性菌的抗菌药物耐药性。
This study was conducted to evaluate the relationship between antimicrobial resistance and antimicrobial use in a university hospital in Taiwan. Disk susceptibility data of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus spp., Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia and other non-fermentative Gram-negative bacilli causing nosocomial infections were evaluated. Data on annual patient-days and annual consumption (defined daily dose (DDD) per 1000 patient-days) of extended-spectrum cephalosporins (cefotaxime, ceftriaxone, ceftazidime, flumoxef, cefepime and cefpirome), β-lactam–β-lactamase inhibitor combinations (ticarcillin/clavulanic acid and piperacillin/tazobactam), carbapenems (imipenem and meropenem), aminoglycosides (amikacin, gentamicin and tobramycin), fluoroquinolones (ciprofloxacin (oral and injectable) and oral levofloxacin and moxifloxacin) from 1991 to 2003 were analysed. Increasing trends of incidences of several of these bacteria causing all nosocomial infections or nosocomial bloodstream infections were noted from 1991 to 2003. The annual patient-days of the hospital significantly increased, from 360 210 in 1991 to 672 676 in 2002 (linear regression analysis, P < 0.05), but slightly decreased in 2003 (629 168) owing to the severe acute respiratory syndrome epidemic in Taiwan. The rise in cefotaxime-resistant or ciprofloxacin-resistant E. coli and meropenem-resistant P. aeruginosa was significantly correlated with increased consumption of extended-spectrum cephalosporins, β-lactam–β-lactamase inhibitor combinations, carbapenems, fluoroquinolones and aminoglycosides (for ciprofloxacin-resistant E. coli and meropenem-resistant P. aeruginosa only) in the hospital (Pearson's correlation coefficient, r > 0.72 (or <−0.72) and P-value < 0.05). Increased ciprofloxacin-resistant K. pneumoniae and meropenem-resistant Acinetobacter spp. was significantly associated with the increased usage of extended-spectrum cephalosporins but not with the other four classes of antibiotics. This 13-year study in a hospital demonstrated significant changes in antimicrobial use, which may have affected antimicrobial resistance in certain Gram-negative bacteria at the hospital.
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