Le Floch Ronan, Arnould Jean François, Pilorget Alain
Anaesthesiology and Reanimations, Pr M. PINAUD, CHU Nantes, Bd Jean Monnet, 44093 Nantes Cedex 01, France.
Burns. 2005 Nov;31(7):866-9. doi: 10.1016/j.burns.2005.04.031. Epub 2005 Jul 21.
This study took place over 18 months and was divided into three 6 month periods. During the first and third periods, the bacterial ecology of the unit was reviewed, including the observation of bacteria which were isolated and led us to prescribe general antimicrobial therapy, and record the subsequent antibiograms that became available. During the second 6 month period, any patient developing an infection due (or possibly due) to a "Gram negative" strain received imipenem (as beta lactam antimicrobial agent), usually combined with tobramycin. The comparison between bacteria and antibiograms isolated during the first and the third periods did not show any increase in multiple resistant bacteria or imipenem resistant strains, including methicillin resistant Staphylococcus aureus (MRSA). During the third period, in comparison with the first, the number of Pseudomonas aeruginosa and Acinetobacter strains was lower; however, the number of Enterobacter and Klebsiella had increased. There was an increase of overall resistance to ticarcillin, but there was no increase in resistance to the other antimicrobials concerned in the study. Therefore, we concluded that wide use of imipenem did not impair the bacterial ecology of the unit, if used with precautions such as high dose regimen, de-escalation, and both pharmacokinetics and ecology monitoring.
本研究历时18个月，分为三个6个月的阶段。在第一阶段和第三阶段，对该科室的细菌生态学进行了评估，包括观察分离出的导致我们开具一般抗菌治疗的细菌，并记录随后可得的抗菌谱。在第二个6个月阶段，任何因（或可能因）“革兰氏阴性”菌株感染的患者接受亚胺培南（作为β-内酰胺类抗菌剂）治疗，通常联合妥布霉素。第一阶段和第三阶段分离出的细菌与抗菌谱之间的比较未显示多重耐药菌或亚胺培南耐药菌株（包括耐甲氧西林金黄色葡萄球菌（MRSA））有任何增加。在第三阶段，与第一阶段相比，铜绿假单胞菌和不动杆菌菌株的数量有所减少；然而，肠杆菌和克雷伯菌的数量有所增加。对替卡西林的总体耐药性有所增加，但对本研究中涉及的其他抗菌药物的耐药性没有增加。因此，我们得出结论，如果采取高剂量方案、降阶梯治疗以及药代动力学和生态学监测等预防措施，广泛使用亚胺培南不会损害该科室的细菌生态学。
