McGowan J E
Epidemiology Department, Rollins School of Public Health of Emory University, Atlanta, Georgia 30322, USA.
Infect Control Hosp Epidemiol. 2000 Jan;21(1 Suppl):S36-43. doi: 10.1086/503172.
Resistant bacteria usually are seen first in the intensive care unit and other acute-care areas. Thus, strategies to control these organisms often are first tested in these healthcare settings. Frequent among these strategies are attempts to improve antimicrobial use. One proposed method to decrease resistance in special settings like the intensive care unit is the cycling or rotation of antimicrobials. This intervention must be evaluated in the context of other concomitant attempts to improve antimicrobial usage and must take into account other factors influencing resistance. Until such studies are done, the value of cycling and other efforts to limit prescribers' choices of drugs in endemic settings will be unclear. Studies to evaluate cycling will have to be of large scale to produce useful data. It is unlikely that many hospitals or healthcare systems will have sufficient resources on their own to develop studies of sufficient power to be applied widely. Thus, cooperative studies to provide data on this important issue should be an international priority.
耐药菌通常首先出现在重症监护病房和其他急症护理区域。因此，控制这些微生物的策略通常首先在这些医疗环境中进行测试。这些策略中常见的是试图改善抗菌药物的使用。在重症监护病房等特殊环境中减少耐药性的一种提议方法是抗菌药物的循环使用或轮换。这种干预措施必须在其他改善抗菌药物使用的同时进行的尝试的背景下进行评估，并且必须考虑到影响耐药性的其他因素。在进行此类研究之前，在地方病环境中循环使用抗菌药物以及其他限制处方者药物选择的努力的价值将尚不清楚。评估循环使用抗菌药物的研究必须规模庞大才能产生有用的数据。许多医院或医疗系统不太可能仅凭自身拥有足够的资源来开展具有足够效力以便广泛应用的研究。因此，开展合作研究以提供有关这一重要问题的数据应成为国际优先事项。
