Zhao Zong-Min, Chu Yun-Zhuo, Wan Jian-Hua, Bai Yu-Lan, Zhang Jing-Ping, Li Jing-Bo, Wang Xin, Wang Qian, Li Li-Yun, Chen Bai-Yi
Division of Infectious Disease, the First Affiliated Hospital, China Medical University, Shenyang 110001, China.
Zhonghua Nei Ke Za Zhi. 2007 Sep;46(9):714-7.
To investigate the role of replacement of third-generation cephalosporins by piperacillin-tazobactam (pip-tazo) in influencing the colonization of extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli (E. coli) in intestinal tract.
The study was divided into two phases lasting altogether 9 months, namely the pre-replacement phase (phase I, 3 months) and replacement phase (phase II, 6 months). In the latter phase, third-generation cephalosporins was restricted and replaced by pip-tazo. In phase I and phase IIb (the last 3 months of phase II), clinical data and rectal swab were taken for E. coli isolation as follow: within 24 hrs after admission (baseline screening), every week and 48 hrs before discharge. ESBLs production was detected with double disc test. Acquisition rate of ESBLs-producing E. coli were calculated both in ES1 group (patients' rectal swab collected and tests at least 2 times) and ES2 group (ES1 but with negative ESBLs either at the time of screening on admission or at anytime during the hospital stay). Continuous variable was compared using unpaired t-test and categorical variables was compared using Pearson Chi square test. Fisher's exact test was used in the two phases.
In phase IIb, as compared with in phase I, the total consumption of antibiotics other than pip-tazo was reduced by 38.40%, the third-generation cephalosporins consumption was reduced by 70.11%, but pip-tazo consumption was raised by 895.35%. Meanwhile, the acquisition rate of ESBLs-producing E. coli in rectal swab was significantly decreased in phase IIb as compared with phase I (11.4% vs 24.0%) in ES1 group and the same is true in ES2 group (11.8% vs 27.9%).
Replacement of third-generation cephalosporin with pip-tazo can reduce colonization of ESBLs--producing E. coli in intestinal tract.
探讨用哌拉西林-他唑巴坦（pip-tazo）替代第三代头孢菌素对产超广谱β-内酰胺酶（ESBLs）大肠埃希菌在肠道定植的影响。
本研究共分为两个阶段，历时9个月，即替换前阶段（第一阶段，3个月）和替换阶段（第二阶段，6个月）。在第二阶段，第三代头孢菌素受到限制并被pip-tazo替代。在第一阶段和第二阶段b（第二阶段的最后3个月），采集临床数据和直肠拭子以分离大肠埃希菌，具体如下：入院后24小时内（基线筛查）、每周以及出院前48小时。采用双纸片法检测ESBLs的产生情况。计算ES1组（患者直肠拭子采集并检测至少2次）和ES2组（ES1组，但入院筛查时或住院期间任何时间ESBLs均为阴性）中产ESBLs大肠埃希菌的获得率。连续变量采用非配对t检验进行比较，分类变量采用Pearson卡方检验进行比较。两个阶段均采用Fisher确切概率法。
在第二阶段b，与第一阶段相比，除pip-tazo外其他抗生素的总消耗量降低了38.40%，第三代头孢菌素的消耗量降低了70.11%，但pip-tazo的消耗量增加了895.35%。同时，在ES1组中，第二阶段b直肠拭子中产ESBLs大肠埃希菌的获得率与第一阶段相比显著降低（11.4%对24.0%），ES2组情况相同（11.8%对27.9%）。
用pip-tazo替代第三代头孢菌素可减少产ESBLs大肠埃希菌在肠道的定植。
