Damas Pierre, Canivet Jean-Luc, Ledoux Didier, Monchi Mehran, Melin Pierrette, Nys Monique, De Mol Patrick
Department of General Intensive Care, University Hospital Center, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium.
Intensive Care Med. 2006 Jan;32(1):67-74. doi: 10.1007/s00134-005-2805-z. Epub 2005 Nov 25.
To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity.
Prospective study in a mixed ICU with three separated subunits of eight, eight, and ten beds.
The study examined the 1,721 patients with a length of stay longer than 2 days.
Three different antibiotic regimens were used sequentially over 2 years as first-choice empirical treatment: cephalosporins, fluoroquinolone, or a penicillin-beta-lactamase inhibitor combination. Each regimen was applied for 8 months in each subunits of the ICU, using "latin square" design.
We treated 731 infections in 546 patients (32% of patients staying more than 48 h). There were 25.5 ICU-acquired infections per 1,000 patient-days. Infecting pathogens and colonizing bacteria were found in 2,739 samples from 1,666 patients (96.8%). No significant change in global antibiotic susceptibility was observed over time. However, a decrease in the susceptibility of several species was observed for antibiotics used as the first-line therapy in the unit. Selection pressure of antibiotics and occurrence of resistance during treatment was documented within an 8-month rotation period.
Antibiotic use for periods of several months induces bacterial resistance in common pathogens.
确定在抗生素同质化的连续时期内，抗生素类别压力对细菌敏感性的影响。
在一个拥有三个分别为8张、8张和10张床位的混合重症监护病房（ICU）进行前瞻性研究。
该研究检查了1721名住院时间超过2天的患者。
在2年的时间里依次使用三种不同的抗生素方案作为首选经验性治疗：头孢菌素、氟喹诺酮或青霉素 - β - 内酰胺酶抑制剂组合。每个方案在ICU的每个亚单元中应用8个月，采用“拉丁方”设计。
我们治疗了546例患者中的731例感染（占住院超过48小时患者的32%）。每1000个患者日中有25.5例ICU获得性感染。在1666例患者的2739份样本中发现了感染病原体和定植菌（96.8%）。随着时间的推移，未观察到总体抗生素敏感性有显著变化。然而，在该科室用作一线治疗的抗生素中，几种细菌的敏感性有所下降。在8个月的轮换期内记录了抗生素的选择压力和治疗期间耐药性的出现情况。
数月使用抗生素会导致常见病原体产生细菌耐药性。
