Takesue Yoshio, Ohge Hiroki, Sakashita Mitsuru, Sudo Takeshi, Murakami Yoshiaki, Uemura Kenichiro, Sueda Taijiro
Department of Surgery, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
World J Surg. 2006 Jul;30(7):1269-76. doi: 10.1007/s00268-005-0781-7.
Heterogeneous antibiotic use has been suggested to limit the emergence of resistance, but determining the optimal strategy is difficult.
We developed a new strategy, termed "periodic antibiotic monitoring and supervision" (PAMS) program in a non-ICU surgical ward. The 2-year prospective study was divided into a 1-year observation period and a 1-year PAMS period. The use of four major classes of antibiotics in empirical therapy for Gram-negative rod (GNR) infections was supervised. During the PAMS program, recommended, restricted, and off-supervised classes of antibiotics were changed every 3 months according to the usage pattern of the antibiotics in the preceding term.
Cefepime (45.5%) and imipenem/cilastatin (39.4%) were the most common antibiotics of choice during the observation period. The use of these antibiotics decreased significantly during the PAMS period, and that of fluoroquinolones and extended-spectrum penicillin/beta-lactamase inhibitor increased (4.8% vs. 21.4% and 2.4% vs. 21.4%, P<0.01 respectively). Outcome analysis demonstrated a tendency toward reduction in the incidence of resistant GNR infections (P=0.079) and that of Pseudomonas aeruginosa (P=0.053). The incidence of resistant Gram-positive core infections did not decrease. Analysis of antibiotic susceptibility to GNR revealed no significant beneficial results for any antibiotics.
As significant changes were not observed, the PAMS program is not generally applicable and heterogeneous antibiotic use as a way of reducing infections with resistant GNR in non-ICU surgical wards was not established.
已有研究表明，采用不同种类的抗生素可限制耐药性的产生，但确定最佳策略并非易事。
我们在一个非重症监护病房的外科病房制定了一项新策略，称为“定期抗生素监测与监管”（PAMS）计划。这项为期2年的前瞻性研究分为1年观察期和1年PAMS期。对革兰氏阴性杆菌（GNR）感染经验性治疗中四大类抗生素的使用进行监管。在PAMS计划期间，根据上一阶段抗生素的使用模式，每3个月更换一次推荐、限制和非监管类别的抗生素。
在观察期内，头孢吡肟（45.5%）和亚胺培南/西司他丁（39.4%）是最常用的抗生素。在PAMS期间，这些抗生素的使用显著减少，而氟喹诺酮类和广谱青霉素/β-内酰胺酶抑制剂的使用增加（分别为4.8%对21.4%和2.4%对21.4%，P均<0.01）。结果分析显示，耐药GNR感染（P=0.079）和铜绿假单胞菌感染（P=0.053）的发生率有下降趋势。耐革兰氏阳性菌核心感染的发生率未下降。对GNR的抗生素敏感性分析显示，任何一种抗生素均未产生显著有益结果。
由于未观察到显著变化，PAMS计划一般不适用，且未证实采用不同种类的抗生素可减少非重症监护病房外科病房中耐药GNR感染。
