Urbánek K, Kolár M, Lovecková Y, Strojil J, Santavá L
Department of Pharmacology, Faculty of Medicine and University Hospital, Olomouc, Czech Republic.
J Clin Pharm Ther. 2007 Aug;32(4):403-8. doi: 10.1111/j.1365-2710.2007.00836.x.
Klebsiella pneumoniae belongs to important nosocomial pathogens causing mainly hospital-acquired infections. Beta-lactam antibiotics are frequently used in the treatment of infections caused by K. pneumoniae, but by their selection pressure the bacteria become resistant. Excessive use of third-generation cephalosporins is a risk factor for the occurrence and spread of ESBL-producing bacterial strains. The goal of this study was to describe the utilization of third-generation cephalosporins and to analyse their selection pressure on K. pneumoniae in the University Hospital in Olomouc.
Data on the utilization of antibiotics in the hospital were obtained for the period 1997-2005 from the computerized database and expressed in defined daily doses per 100 bed-days (DBD). The data were processed according to the ATC/DDD system. Klebsiella pneumoniae strains were isolated from clinical material obtained from hospitalized patients.
Consumption of third-generation cephalosporins, which was 1.79 DBD in 1997, decreased to 0.93 in 1999, remained stable until 2002, and then increased to 2.40 DBD in 2005. During the 9-year period analysed, a total of 9564 strains of K. pneumoniae were isolated. The ESBL-positive K. pneumoniae strains frequency increased from 8% to 18%.
Increasing utilization of third-generation cephalosporins was associated with a statistically and clinically significant increased incidence of ESBL-positive K. pneumoniae strains.
肺炎克雷伯菌属于重要的医院病原体，主要引起医院获得性感染。β-内酰胺类抗生素常用于治疗肺炎克雷伯菌引起的感染，但在其选择压力下，细菌会产生耐药性。过度使用第三代头孢菌素是产超广谱β-内酰胺酶（ESBL）细菌菌株发生和传播的危险因素。本研究的目的是描述第三代头孢菌素的使用情况，并分析其对奥洛穆茨大学医院肺炎克雷伯菌的选择压力。
从计算机数据库中获取1997 - 2005年期间该医院抗生素使用数据，并以每100床日限定日剂量（DBD）表示。数据根据解剖学治疗学及化学分类系统/限定日剂量（ATC/DDD）系统进行处理。从住院患者的临床材料中分离出肺炎克雷伯菌菌株。
第三代头孢菌素的消耗量在1997年为1.79 DBD，1999年降至0.93，到2002年保持稳定，然后在2005年增至2.40 DBD。在分析的9年期间，共分离出9564株肺炎克雷伯菌。ESBL阳性肺炎克雷伯菌菌株的频率从8%增加到18%。
第三代头孢菌素使用量的增加与ESBL阳性肺炎克雷伯菌菌株的发生率在统计学和临床上显著增加相关。
