季度循环抗生素治疗方案期间耐药铜绿假单胞菌感染的暴发

Outbreak of resistant Pseudomonas aeruginosa infections during a quarterly cycling antibiotic regimen.

作者信息

Hedrick Traci L, Schulman Alison S, McElearney Shannon T, Smith Robert L, Swenson Brian R, Evans Heather L, Truwit Jonathon D, Scheld W Michael, Sawyer Robert G

机构信息

Department of Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.

出版信息

Surg Infect (Larchmt). 2008 Apr;9(2):139-52. doi: 10.1089/sur.2006.102.

DOI:10.1089/sur.2006.102

PMID:18426346

Abstract

BACKGROUND

Antibiotic cycling or rotation of antimicrobial agent classes has been proposed to combat antimicrobial resistance.

METHODS

A prospective cohort study was conducted in a medical intensive care unit (ICU) of a university hospital between December 1, 2000, and September 30, 2002, as part of a three-center trial under the aegis of the U.S. Centers for Disease Control and Prevention. Patients admitted to the medical ICU for > 48 h were enrolled, and demographic and microbiological data were collected until discharge or death. Baseline data were collected for four months (12/1/00 to 3/31/01) and compared with data collected after institution of a quarterly cycling regimen (cycle order: Cefepime, ciprofloxacin, piperacillin-tazobactam, imipenem-cilastatin) for the empiric treatment of gram-negative infections (4/01/01 to 9/30/02).

RESULTS

Of 1,074 consecutive admissions, 301 were enrolled, 59 during baseline and 242 during the cycling periods. An outbreak of multi-drug resistant Pseudomonas aeruginosa followed cycle 2 (cefepime), coinciding with cycles 3 and 4 (ciprofloxacin and piperacillin-tazobactam) (80.0 and 73.7 vs. 37.3 isolates/100 patients enrolled for cycles 3/4 and baseline, respectively; p = 0.04). Acinetobacter spp. were isolated less frequently during the cycling periods (15.3 vs. 1.2 isolates/100 patients for baseline and cycling periods, respectively; p > or = 0.01). The crude hospital mortality rate was similar (24/59 [41%] baseline vs. 73/242 [30%] cycling; p = 0.16) between periods. However, the percentage of patients admitted to the medical ICU who subsequently acquired an infection followed by in-hospital death was higher at baseline than during cycling: 15/59 (25.4%) vs. 33/242 (13.6%)(p = 0.04).

CONCLUSIONS

In this study, the cycling strategy was not definitively associated with beneficial changes in unit epidemiology and in fact may have contributed to an outbreak of multi-drug resistant P. aeruginosa.

摘要

背景

有人提出通过抗生素循环使用或抗菌药物类别轮换的方式来对抗抗菌药物耐药性。

方法

作为美国疾病控制与预防中心支持的一项三中心试验的一部分，于2000年12月1日至2002年9月30日在一所大学医院的内科重症监护病房（ICU）进行了一项前瞻性队列研究。纳入入住内科ICU超过48小时的患者，并收集人口统计学和微生物学数据直至出院或死亡。在四个月（2000年12月1日至2001年3月31日）收集基线数据，并与在实施季度循环方案（循环顺序：头孢吡肟、环丙沙星、哌拉西林-他唑巴坦、亚胺培南-西司他丁）用于革兰氏阴性菌感染经验性治疗后（2001年4月1日至2002年9月30日）收集的数据进行比较。

结果

在1074例连续入院患者中，301例被纳入研究，其中基线期59例，循环期242例。在第2轮循环（头孢吡肟）后发生了耐多药铜绿假单胞菌的暴发，与第3轮和第4轮循环（环丙沙星和哌拉西林-他唑巴坦）同时发生（第3/4轮循环和基线期每100例纳入患者分别分离出80.0株和73.7株，而基线期为37.3株；p = 0.04）。不动杆菌属在循环期的分离频率较低（基线期和循环期每100例患者分别分离出15.3株和1.2株；p≥0.01）。两个时期的粗住院死亡率相似（基线期24/59 [41%] 对循环期73/242 [30%]；p = 0.16）。然而，入住内科ICU后发生感染并随后院内死亡的患者百分比在基线期高于循环期：15/59（25.4%）对33/242（13.6%）（p = 0.04）。