Philippe E, Weiss M, Shultz J M, Yeomans F, Ehrenkranz N J
Florida Consortium for Infection Control, South Miami 33143, USA.
Clin Perform Qual Health Care. 1999 Apr-Jun;7(2):83-7.
This study examines antibiotic resistance in Pseudomonas aeruginosa in hospitalized patients in relation to prior empirical antibiotic therapy.
Two retrospective case analyses comparing patients who manifested P aeruginosa with differing patterns of antibiotic resistance.
Patients acquiring P aeruginosa in a community hospital.
Patients were compared on duration of hospitalization and days and doses of antibiotics prior to recovery of P aeruginosa. Patients were grouped, based on susceptibility patterns of their P aeruginosa isolates classified as follows: (1) fully susceptible (susceptible to all classes of antipseudomonal antibiotics [SPA]), (2) multidrug-resistant (resistant to two classes of antipseudomonal antibiotics [MDRPA]), or (3) highly drug-resistant (resistant to > or = 6 classes of antipseudomonal antibiotics [HRPA]). To control for duration of hospitalization, antibiotic treatments of HRPA and SPA patients were compared during the first 21 days of care.
Prior to recovery of HRPA, six HRPA patients received greater amounts of antibiotics, both antipseudomonal and non-antipseudomonal, than did six SPA patients prior to recovery of SPA. For 14 patients with hospital-acquired SPA who later manifested MDRPA, duration and dosage of antipseudomonal antibiotics, but not all antibiotics, were significantly higher for the SPA-to-MDRPA interval than for the preceding admission-to-SPA interval. The median duration of antipseudomonal antibiotic treatment prior to the recovery of P aeruginosa was 0 days for SPA, 11 days for MDRPA, and 24 days for HRPA.
Duration of empirical antipseudomonal antibiotic treatment influences selection of resistant strains of P aeruginosa; the longer the duration, the broader the pattern of resistance.
本研究调查住院患者铜绿假单胞菌的抗生素耐药性与先前经验性抗生素治疗的关系。
两项回顾性病例分析，比较表现出不同抗生素耐药模式的铜绿假单胞菌患者。
在一家社区医院感染铜绿假单胞菌的患者。
比较患者的住院时间以及铜绿假单胞菌恢复之前使用抗生素的天数和剂量。根据其铜绿假单胞菌分离株的药敏模式将患者分组如下：（1）完全敏感（对所有抗假单胞菌抗生素类敏感[SPA]），（2）多重耐药（对两类抗假单胞菌抗生素耐药[MDRPA]），或（3）高度耐药（对≥6类抗假单胞菌抗生素耐药[HRPA]）。为控制住院时间，比较了HRPA和SPA患者在护理的前21天内的抗生素治疗情况。
在HRPA恢复之前，6例HRPA患者在抗假单胞菌和非抗假单胞菌抗生素的使用量上均高于6例SPA患者在SPA恢复之前的用量。对于14例后来表现为MDRPA的医院获得性SPA患者，抗假单胞菌抗生素（而非所有抗生素）在从SPA到MDRPA阶段的使用时间和剂量显著高于之前从入院到SPA阶段。铜绿假单胞菌恢复之前抗假单胞菌抗生素治疗的中位时间，SPA为0天，MDRPA为11天，HRPA为24天。
经验性抗假单胞菌抗生素治疗的持续时间会影响铜绿假单胞菌耐药菌株的选择；持续时间越长，耐药模式越广泛。
