Blot Stijn, Depuydt Pieter, Vogelaers Dirk, Decruyenaere Johan, De Waele Jan, Hoste Eric, Peleman Renaat, Claeys Geert, Verschraegen Gerda, Colardyn Francis, Vandewoude Koenraad
Department of Intensive Care, Ghent University Hospital, Gent, Belgium.
Infect Control Hosp Epidemiol. 2005 Jun;26(6):575-9. doi: 10.1086/502575.
Timely initiation of antibiotic therapy is crucial for severe infection. Appropriate antibiotic therapy is often delayed for nosocomial infections caused by antibiotic-resistant bacteria. The relationship between knowledge of colonization caused by antibiotic-resistant gram-negative bacteria (ABR-GNB) and rate of appropriate initial antibiotic therapy for subsequent bacteremia was evaluated.
Retrospective cohort study.
Fifty-four-bed intensive care unit (ICU) of a university hospital. In this unit, colonization surveillance is performed through routine site-specific surveillance cultures (urine, mouth, trachea, and anus). Additional cultures are performed when presumed clinically relevant.
ICU patients with nosocomial bacteremia caused by ABR-GNB.
Infectious and microbiological characteristics and rates of appropriate antibiotic therapy were compared between patients with and without colonization prior to bacteremia. Prior colonization was defined as the presence (detected > or = 2 days before the onset of bacteremia) of the same ABR-GNB in colonization and subsequent blood cultures. During the study period, 157 episodes of bacteremia caused by ABR-GNB were suitable for evaluation. One hundred seventeen episodes of bacteremia (74.5%) were preceded by colonization. Appropriate empiric antibiotic therapy (started within 24 hours) was administered for 74.4% of these episodes versus 55.0% of the episodes that occurred without prior colonization. Appropriate therapy was administered within 48 hours for all episodes preceded by colonization versus 90.0% of episodes without prior colonization.
Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB.
及时开始抗生素治疗对于严重感染至关重要。对于由耐抗生素细菌引起的医院感染，适当的抗生素治疗常常延迟。评估了对抗生素耐药革兰氏阴性菌（ABR - GNB）定植的认知与随后菌血症的适当初始抗生素治疗率之间的关系。
回顾性队列研究。
一所大学医院的拥有54张床位的重症监护病房（ICU）。在该病房，通过常规的特定部位监测培养（尿液、口腔、气管和肛门）进行定植监测。当临床认为有相关性时进行额外培养。
由ABR - GNB引起医院获得性菌血症的ICU患者。
比较了菌血症发生前有定植和无定植患者的感染及微生物学特征以及适当抗生素治疗率。先前定植定义为在定植培养和随后的血培养中存在相同的ABR - GNB（在菌血症发作前≥2天检测到）。在研究期间，157例由ABR - GNB引起的菌血症发作适合评估。117例菌血症发作（74.5%）之前有定植。这些发作中有74.4%接受了适当的经验性抗生素治疗（在24小时内开始），而无先前定植的发作中这一比例为55.0%。对于所有有先前定植的发作，在48小时内给予了适当治疗，而无先前定植的发作这一比例为90.0%。
感染前的定植状态认知与ABR - GNB引起菌血症患者的更高适当治疗率相关。
