Erlandsson Marcus, Burman Lars G, Cars Otto, Gill Hans, Nilsson Lennart E, Walther Sten M, Hanberger Håkan
University Hospital Linköping, Stockholm, Sweden.
Scand J Infect Dis. 2007;39(1):63-9. doi: 10.1080/00365540600740504.
Since the prescription of antibiotics in the hospital setting is often empiric, particularly in the critically ill, and therefore fraught with potential error, we analysed the use of antibiotic agents in Swedish intensive care units (ICUs). We examined indications for antibiotic treatment, agents and dosage prescribed among 393 patients admitted to 23 ICUs at 7 tertiary care centres, 11 secondary hospitals and 5 primary hospitals over a 2-week period in November 2000. Antibiotic consumption was higher among ICU patients in tertiary care centres with a median of 84% (range 58-87%) of patients on antibiotics compared to patients in secondary hospitals (67%, range 35-93%) and in primary hospitals (38%, range 24-80%). Altogether 68% of the patients received antibiotics during the ICU stay compared to 65% on admission. Cefuroxime was the most commonly prescribed antibiotic before and during admission (28% and 24% of prescriptions, respectively). A date for decision to continue or discontinue antibiotic therapy was set in 21% (6/29) of patients receiving prophylaxis, in 8% (16/205) receiving empirical treatment and in 3% (3/88) when culture-based therapy was given. No correlation between antibiotic prescription and laboratory parameters such as CRP levels, leukocyte and thrombocyte counts, was found. The treatment was empirical in 64% and prophylactic in 9% of cases. Microbiological data guided prescription more often in severe sepsis (median 50%, range 40-60% of prescriptions) than in other specified forms of infection (median 32%, range 21-50%). The empirically chosen antibiotic was found to be active in vitro against the pathogens found in 55 of 58 patients (95%) with a positive blood culture. This study showed that a high proportion of ICU patients receive antimicrobial agents and, as expected, empirical-based therapy is more common than culture-based therapy. Antibiotics given were usually active in vitro against the pathogen found in blood cultures. We ascribe this to a relatively modest antibiotic resistance problem in Swedish hospitals.
由于医院环境中抗生素的处方往往是经验性的，尤其是在危重症患者中，因此存在潜在错误，我们分析了瑞典重症监护病房（ICU）中抗生素的使用情况。我们调查了2000年11月为期两周内，7家三级护理中心、11家二级医院和5家一级医院的23个ICU收治的393例患者的抗生素治疗指征、所开药物及剂量。三级护理中心ICU患者的抗生素消耗量更高，使用抗生素的患者中位数为84%（范围58 - 87%），而二级医院患者为67%（范围35 - 93%），一级医院患者为38%（范围24 - 80%）。共有68%的患者在ICU住院期间接受了抗生素治疗，入院时这一比例为65%。头孢呋辛是入院前和入院期间最常开具的抗生素（分别占处方的28%和24%）。在接受预防性治疗的患者中，21%（6/29）设定了继续或停止抗生素治疗的决定日期；在接受经验性治疗的患者中，8%（16/205）设定了该日期；在接受基于培养的治疗的患者中，3%（3/88）设定了该日期。未发现抗生素处方与CRP水平、白细胞和血小板计数等实验室参数之间存在相关性。64%的病例治疗是经验性的，9%是预防性的。微生物学数据指导处方在严重脓毒症中比在其他特定形式的感染中更常见（处方中位数分别为50%，范围40 - 60%和32%，范围21 - 50%）。在58例血培养阳性的患者中，有55例（95%）患者经验性选用的抗生素在体外对所发现的病原体有活性。这项研究表明，很大一部分ICU患者接受了抗菌药物治疗，正如预期的那样，基于经验的治疗比基于培养的治疗更常见。所使用的抗生素通常在体外对血培养中发现的病原体有活性。我们将此归因于瑞典医院相对较小的抗生素耐药性问题。
