Meyer E, Schwab F, Gastmeier P, Rueden H, Daschner F D
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Breisacher Str. 115B, 79106, Freiburg, Germany.
Infection. 2006 Dec;34(6):303-9. doi: 10.1007/s15010-006-6619-x.
To report the experience gained over 4 years in working with the German SARI project (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), and to compare SARI with data from the Swedish STRAMA and the US AUR surveillance system.
Prospective unit and laboratory based surveillance was carried out in 40 German ICUs from 2001 through 2004. WHO 2004 definitions of defined daily doses (DDD) per 1,000 patient days (pd) were used to express antimicrobial consumption (AD). Apart from the proportion of resistant isolates (RP), the incidence density of resistant isolates (RD) was calculated on the basis of the number of resistant isolates per 1,000 pd. To determine the changes over time, the Wilcoxon signed rank test for paired samples was used.
From 1/2001 through 12/2004, 40 ICUs provided data on 53,399 isolates, a total of 789,569 DDD and 597,592 pd. Total AD ranged from 427 to 2,798, with the median being 1,351. There was no statistically significant change in total antimicrobial use, but a statistically significant decrease was observed in the use of aminoglycosides. RD was highest for MRSA with 4.4 resistant isolates/1,000 pd followed by imipenem resistant Pseudomonas aeruginosa with 1.7 resistant isolates/1,000 pd. The corresponding RPs were 21.5% and 23.2%. Over the 4-year period (2001-2004), significant increases were seen in the RDs of third generation cephalosporin and ciprofloxacin resistant Escherichia coli. In 2004, the mean RD reached 0.28 and 1.41, respectively. In comparison, the RP of selected pathogens was highest in the US ICUs and lowest in Swedish ICUs, with the exception of imipenem resistant P. aeruginosa.
Antibiotic consumption remained stable over a period of 4 years, (the mean being 1,321 DDD/1,000 pd). The same applied to the situation regarding resistance in Staphylococcus aureus, enterococci and P. aeruginosa. For most pathogens the RP was higher in SARI ICUs than in Swedish ICUs, but lower than in US ICUs.
报告在参与德国重症监护病房抗菌药物使用与耐药性监测（SARI）项目4年期间所积累的经验，并将SARI与瑞典的STRAMA以及美国的AUR监测系统的数据进行比较。
2001年至2004年期间，对德国40个重症监护病房进行了基于病房和实验室的前瞻性监测。采用世界卫生组织2004年每1000患者日（pd）限定日剂量（DDD）的定义来表示抗菌药物消耗量（AD）。除了耐药菌株比例（RP）外，还根据每1000 pd的耐药菌株数量计算耐药菌株的发病密度（RD）。为了确定随时间的变化情况，使用配对样本的Wilcoxon符号秩检验。
从2001年1月至2004年12月，40个重症监护病房提供了53399株菌株的数据，共计789569个DDD和597592个pd。总AD范围为427至2798，中位数为1351。抗菌药物总使用量无统计学显著变化，但氨基糖苷类药物的使用量有统计学显著下降。MRSA的RD最高，为4.4株耐药菌株/1000 pd，其次是对亚胺培南耐药的铜绿假单胞菌，为1.7株耐药菌株/1000 pd。相应的RP分别为21.5%和23.2%。在4年期间（从2001年至2004年），第三代头孢菌素和对环丙沙星耐药的大肠杆菌的RD有显著增加。2004年，平均RD分别达到0.28和1.41。相比之下，除了对亚胺培南耐药的铜绿假单胞菌外，所选病原体的RP在美国重症监护病房最高，在瑞典重症监护病房最低。
在4年期间抗生素消耗量保持稳定（平均为1321 DDD/1000 pd）。金黄色葡萄球菌、肠球菌和铜绿假单胞菌的耐药情况也是如此。对于大多数病原体，SARI重症监护病房的RP高于瑞典重症监护病房，但低于美国重症监护病房。
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