Kollef M H, Ward S, Sherman G, Prentice D, Schaiff R, Huey W, Fraser V J
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Crit Care Med. 2000 Oct;28(10):3456-64. doi: 10.1097/00003246-200010000-00014.
The purpose of this study was to determine the impact of scheduled changes of antibiotic classes, used for the empirical treatment of suspected or documented Gram-negative bacterial infections, on the occurrence of inadequate antimicrobial treatment of nosocomial infections.
Prospective observational study.
Medical (19-bed) and surgical (18-bed) intensive care units in an urban teaching hospital.
A total of 3,668 patients requiring intensive care unit admission were prospectively evaluated during three consecutive time periods.
During each time period, one antibiotic class was selected for the empirical treatment of Gram-negative bacterial infections as follows: time period 1 (baseline period) (1,323 patients), ceftazidime; time period 2 (1,243 patients), ciprofloxacin; and time period 3 (1,102 patients), cefepime.
The overall administration of inadequate antimicrobial treatment for nosocomial infections decreased during the course of the study (6.1%, 4.7%, and 4.5%; p = .15). This was primarily because of a statistically significant decrease in the administration of inadequate antibiotic treatment for Gram-negative bacterial infections (4.4%, 2.1%, and 1.6%; p < .001). There were no statistically significant differences in the overall hospital mortality rate among the three time periods (15.6%, 16.4%, and 16.2%; p = .828) despite a significant increase in severity of illness as measured with Acute Physiology and Chronic Health Evaluation (APACHE) II scores (15.3 +/- 7.6, 15.7 +/- 8.0, and 20.7 +/- 8.6; p < .001). The hospital mortality rate decreased significantly during time period 3 (20.6%) compared with time period 1 (28.4%; p < .001) and time period 2 (29.5%; p < .001) for patients with an APACHE II score > or = 15.
These data suggest that scheduled changes of antibiotic classes for the empirical treatment of Gram-negative bacterial infections can reduce the occurrence of inadequate antibiotic treatment for nosocomial infections. Reducing inadequate antibiotic administration may improve the outcomes of critically ill patients with APACHE II scores > or = 15.
本研究旨在确定用于疑似或确诊革兰氏阴性菌感染经验性治疗的抗生素类别定期更换，对医院感染抗菌治疗不足发生率的影响。
前瞻性观察性研究。
城市教学医院的内科（19张床位）和外科（18张床位）重症监护病房。
在连续三个时间段内，对总共3668例需要入住重症监护病房的患者进行前瞻性评估。
在每个时间段，选择一种抗生素类别用于革兰氏阴性菌感染的经验性治疗，如下：时间段1（基线期）（1323例患者），头孢他啶；时间段2（1243例患者），环丙沙星；时间段3（1102例患者），头孢吡肟。
在研究过程中，医院感染抗菌治疗不足的总体发生率有所下降（6.1%、4.7%和4.5%；p = 0.15）。这主要是因为革兰氏阴性菌感染抗生素治疗不足的发生率有统计学意义的下降（4.4%、2.1%和1.6%；p < 0.001）。尽管用急性生理与慢性健康状况评价系统（APACHE）II评分衡量的疾病严重程度显著增加（15.3±7.6、15.7±8.0和20.7±8.6；p < 0.001），但三个时间段的总体医院死亡率无统计学显著差异（15.6%、16.4%和16.2%；p = 0.828）。对于APACHE II评分≥15的患者，与时间段1（28.4%；p < 0.001）和时间段2（29.5%；p < 0.001）相比，时间段3的医院死亡率显著下降（20.6%）。
这些数据表明，用于革兰氏阴性菌感染经验性治疗的抗生素类别定期更换，可降低医院感染抗生素治疗不足的发生率。减少抗生素使用不足可能改善APACHE II评分≥15的重症患者的预后。
Zotero 插件