Association between antibiotic usage and subsequent colonization or infection of extensive drug-resistant Acinetobacter baumannii: a matched case-control study in intensive care units
Association between antibiotic usage and subsequent colonization or infection of extensive drug-resistant Acinetobacter baumannii: a matched case-control study in intensive care units
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DOI：
10.1016/j.diagmicrobio.2008.06.017
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发表时间：
2008-11-01
影响因子：
2.9
通讯作者：
Chang, Shan-Chwen
中科院分区：
文献类型：
--
作者：
Tsai, Hue-Ting;Wang, Jann-Tay;Chang, Shan-Chwen
广泛耐药鲍曼不动杆菌 (EDRAB) 的医院传播是一个新出现的问题。为了阐明先前使用抗生素与随后获得 EDRAB 之间的关联，我们在台湾台北国立台湾大学医院所有重症监护病房 (ICU) 的患者中进行了一项为期 1 年的一对一匹配病例对照研究。总共确定了 113 对患者。我们从四个角度测量了既往抗生素暴露情况：使用情况、总体治疗持续时间、累积剂量和治疗效力。我们发现 EDRAB 获取与先前使用亚胺培南和美罗培南之间的 4 项指标呈正相关，特别是在使用和平均治疗效力方面（使用、比值比 [OR](亚胺培南) = 3.7，95% 置信区间 [CI] = 1.2-11.0，OR美罗培南 = 5.4，95% CI = 1.2-20.0；平均治疗效力，[OR](亚胺培南) = 5.3，95% CI = 1.3-22.0，奥美罗培南 = 3.4，95% CI = 1.0-12.0）。使用具有更强治疗效力的头孢他啶也与随后的院内 EDRAB 获得密切相关（OR = 5.5，95% CI = 1.5-21.0）。对于先前接触过上述抗生素中的任意 1 种（OR = 5.5，95% CI = 2.3-13.2）或任意 2 种或 3 种（OR = 11.1，95% CI = 2.7-46.4）的患者，获得 EDRAB 的 OR 大大增加。基于这些发现，我们得出结论，亚胺培南、美罗培南和/或头孢他啶的使用与 ICU 危重患者随后获得 EDRAB 相关。 (C) 2008 Elsevier Inc. 保留所有权利。
Nosocomial spreading of extensive drug-resistant Acinetobacter baumannii (EDRAB) is an emerging problem. To clarify the association between prior antibiotic usage and subsequent EDRAB acquisition, we conducted a one-to-one matched case-control study among patients in all intensive care units (ICUs) at the National Taiwan University Hospital, Taipei, Taiwan, during a 1-year period. A total of 113 pairs of patients were identified. We measured prior antibiotics exposure in 4 perspectives: usage, overall treatment duration, accumulated dosage, and treatment potency. We found positive associations between EDRAB acquisition and prior usage of imipenem and meropenem across 4 measures, especially in usage and average treatment potency (usage, odds ratio [OR](imipenem) = 3.7 with 95% confidence interval [CI] = 1.2-11.0, ORmeropenem = 5.4 with 95% CI = 1.2-20.0; average treatment potency, [OR](imipenem) = 5.3 with 95% CI = 1.3-22.0, ORmeropenem = 3.4 with 95% CI = 1.0-12.0). Ceftazidime use with stronger treatment potency was also strongly associated with subsequent nosocomial EDRAB acquisition (OR = 5.5, 95% CI = 1.5-21.0). The OR of EDRAB acquisition greatly increased in patients who had previously been exposed to any 1 (OR = 5.5, 95% CI = 2.3-13.2) or to any 2 or 3 (OR = 11.1, 95% CI = 2.7-46.4) of the abovementioned antibiotics. Based on these findings, we conclude that usage of imipenem, meropenem, and/or ceftazidime is associated with subsequent acquisition of EDRAB in critically ill patients in ICUs. (C) 2008 Elsevier Inc. All rights reserved.