在外科重症监护病房实施抗生素轮换方案可改善抗生素敏感性情况。

Implementation of antibiotic rotation protocol improves antibiotic susceptibility profile in a surgical intensive care unit.

作者信息

Bennett Kyla M, Scarborough John E, Sharpe Michelle, Dodds-Ashley Elizabeth, Kaye Keith S, Hayward Thomas Z, Vaslef Steven N

机构信息

Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.

出版信息

J Trauma. 2007 Aug;63(2):307-11. doi: 10.1097/TA.0b013e318120595e.

DOI:10.1097/TA.0b013e318120595e

PMID:17693828

Abstract

BACKGROUND

Antibiotic rotation has been proposed as a way to potentially reduce the development of antimicrobial resistant bacteria in intensive care units. We assessed the effect of an antibiotic rotation protocol on the antibiotic susceptibility profiles of three clinically relevant gram-negative microorganisms within our surgical intensive care unit (SICU).

METHODS

Our SICU implemented an antibiotic rotation protocol in 2003. Four antibiotics (piperacillin/tazobactam, imipenem/cilastin, ceftazidime, and ciprofloxacin) were rotated as the primary antibiotic used to treat suspected gram-negative infections every month, with the four-drug cycle being repeated every 4 months. Antibiotic susceptibility data for three microorganisms (Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae) were collected for the year before (2002) and the year after (2004) the implementation of the rotation protocol. Changes in antimicrobial susceptibility rates were analyzed for the three microorganisms. As a comparison, a similar analysis was conducted for microorganisms isolated from our medical intensive care unit, where no antibiotic rotation protocol was implemented.

RESULTS

Implementation of an antibiotic rotation protocol in our SICU resulted in a significant increase in the percentage of P. aeruginosa isolates sensitive to ceftazidime (67% in 2002 vs. 92% in 2004, p = 0.002) and piperacillin/tazobactam (78% in 2002 vs. 92% in 2004, p = 0.043). Isolates from the medical intensive care unit did not demonstrate an increase in antimicrobial susceptibility. In fact, the susceptibility of E. coli to piperacillin/tazobactam decreased during this time period (p = 0.047).

CONCLUSIONS

Implementation of an antibiotic rotation protocol in our SICU resulted in overall improvement in the antibiotic susceptibility profile of gram-negative microorganisms relative to our medical intensive care unit, where such a protocol was not used.

摘要

背景

抗生素轮换已被提议作为一种可能减少重症监护病房中抗菌药物耐药菌产生的方法。我们评估了抗生素轮换方案对我们外科重症监护病房（SICU）内三种临床相关革兰氏阴性微生物的抗生素敏感性谱的影响。

方法

我们的SICU于2003年实施了抗生素轮换方案。四种抗生素（哌拉西林/他唑巴坦、亚胺培南/西司他丁、头孢他啶和环丙沙星）每月轮换作为用于治疗疑似革兰氏阴性感染的主要抗生素，每4个月重复一次四药周期。收集了实施轮换方案前一年（2002年）和后一年（2004年）三种微生物（铜绿假单胞菌、大肠杆菌和肺炎克雷伯菌）的抗生素敏感性数据。分析了这三种微生物抗菌药物敏感性率的变化。作为对照，对从我们未实施抗生素轮换方案的内科重症监护病房分离出的微生物进行了类似分析。

结果

在我们的SICU实施抗生素轮换方案导致对头孢他啶敏感的铜绿假单胞菌分离株百分比显著增加（2002年为67%，2004年为92%，p = 0.002）以及对哌拉西林/他唑巴坦敏感的铜绿假单胞菌分离株百分比显著增加（2002年为78%，2004年为92%，p = 0.043）。来自内科重症监护病房的分离株未显示抗菌药物敏感性增加。事实上，在此期间大肠杆菌对哌拉西林/他唑巴坦的敏感性下降（p = 0.047）。