Fridkin Scott K
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
Clin Infect Dis. 2003 Jun 1;36(11):1438-44. doi: 10.1086/375082. Epub 2003 May 20.
Antimicrobial cycling is the deliberate, scheduled removal and substitution of specific antimicrobials or classes of antimicrobials within an institutional environment (either hospital-wide or confined to specific units) to avoid or reverse the development of antimicrobial resistance. True antimicrobial cycling requires a return to the antimicrobial(s) that were first used. Testing of the hypothesis that cycling will result in a lower prevalence of resistance is ongoing, mostly occurs within intensive care units, and largely involves cycling regimens targeted for treatment of suspected gram-negative bacterial infections. Unfortunately, there has been insufficient study to determine whether any meaningful impact on resistance has occurred as a result of a cycling program. Mathematical models question the usefulness of cycling as an infection-control method. Published studies demonstrate that cycling may be one way to change prescribing practices by clinicians without sacrificing patient safety. However, optimizing antimicrobial use through traditional and novel methods (e.g., computer decision support) should not be abandoned.
抗菌药物轮换是指在医疗机构环境（全院范围或特定科室）中有计划地定期停用并替换特定抗菌药物或抗菌药物类别，以避免或扭转抗菌药物耐药性的产生。真正的抗菌药物轮换需要重新使用最初使用的抗菌药物。关于轮换是否会降低耐药性发生率这一假设的验证工作正在进行中，主要在重症监护病房开展，并且很大程度上涉及针对疑似革兰氏阴性菌感染治疗的轮换方案。遗憾的是，目前尚无足够的研究来确定轮换方案是否对耐药性产生了任何有意义的影响。数学模型对轮换作为一种感染控制方法的有效性提出质疑。已发表的研究表明，轮换可能是一种在不牺牲患者安全的情况下改变临床医生用药习惯的方法。然而，不应放弃通过传统和新型方法（如计算机决策支持）优化抗菌药物使用的做法。
