Hall Charles Scott, Ost David E
Center for Pulmonary and Critical Care Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.
Semin Respir Infect. 2003 Jun;18(2):112-21.
Resistance of microbes to antibiotics is an increasing problem in intensive care units (ICUs) with a prevalence of 86% in some isolates. Resistance results in increased morbidity, mortality, and increased costs. Risk factors associated with the development of resistance and strategies to combat resistance are discussed. Risk factors include increased antibiotic use, host factors including severity of illness and length of stay, and lack of adherence to infection control practices. Multiple strategies to decrease resistance have been studied. Changing antimicrobial practices via guideline development, antibiotic restriction, use of information systems technology, crop rotation, narrowing spectrum of empiric antibiotics, multidisciplinary approaches, and selective decontamination have had variable results. Prevention of horizontal transmission via handwashing, glove and gown use, alternatives to soap, and improving the workload and facilities for health care workers is discussed. Primary prevention via decreased length of stay, selective digestive decontamination, vaccine development, and decreased use of invasive devices also plays a role.
在重症监护病房（ICU）中，微生物对抗生素的耐药性问题日益严重，某些分离株的耐药率高达86%。耐药性导致发病率和死亡率增加，成本上升。本文讨论了与耐药性发展相关的风险因素以及对抗耐药性的策略。风险因素包括抗生素使用增加、宿主因素（如疾病严重程度和住院时间）以及缺乏对感染控制措施的依从性。人们已经研究了多种降低耐药性的策略。通过制定指南、限制抗生素使用、利用信息系统技术、轮换用药、缩小经验性抗生素的抗菌谱、采用多学科方法以及选择性去污等方式来改变抗菌措施，取得了不同的效果。本文还讨论了通过洗手、使用手套和隔离衣、使用替代肥皂的产品以及改善医护人员的工作量和设施来预防水平传播。通过缩短住院时间、选择性消化道去污、疫苗研发以及减少侵入性设备的使用进行一级预防也发挥着作用。
