Ryan Richard J, Lindsell Chris, Sheehan Paul
Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, Ohio 45267-0769, USA.
BMC Infect Dis. 2008 May 24;8:71. doi: 10.1186/1471-2334-8-71.
Moxifloxacin is a respiratory fluoroquinolone with a community acquired pneumonia indication. Unlike other fluoroquinolones used in our healthcare system, moxifloxacin's urinary excretion is low and thus we hypothesized that increased use of moxifloxacin is associated with an increase in fluoroquinolone resistance amongst gram negative uropathogens.
All antibiograms for Gram negative bacteria were obtained for 2000 to 2005. The defined daily dose (DDD) for each fluoroquinolone was computed according to World Health Organization criteria. To account for fluctuation in patient volume, DDD/1000 bed days was computed for each year of study. Association between DDD/1000 bed days for each fluoroquinolone and the susceptibility of Gram negative bacteria to ciprofloxacin was assessed using Pearson's Correlation Coefficient, r.
During the study period, there were 48,261 antibiograms, 347,931 DDD of fluoroquinolones, and 1,943,338 bed days. Use of fluoroquinolones among inpatients decreased from 237.2 DDD/1000 bed days in 2000 to 115.2 DDD/1000 bed days in 2005. With the exception of Enterobacter aerogenes, moxifloxacin use was negatively correlated with sensitivity among all 13 Gram negative species evaluated (r = -0.07 to -0.97). When the sensitivities of all Gram negative organisms were aggregated, all fluoroquinolones except moxifloxacin were associated with increased sensitivity (r = 0.486 to 1.000) while moxifloxacin was associated with decreased sensitivity (r = -0.464).
Moxifloxacin, while indicated for empiric treatment of community acquired pneumonia, may have important negative influence on local antibiotic sensitivities amongst Gram negative organisms. This effect was not shared by other commonly used members of the fluoroquinolone class.
莫西沙星是一种用于治疗社区获得性肺炎的呼吸喹诺酮类药物。与我们医疗系统中使用的其他喹诺酮类药物不同，莫西沙星的尿排泄率较低，因此我们推测，莫西沙星使用量的增加与革兰氏阴性尿路病原体对喹诺酮类药物耐药性的增加有关。
获取2000年至2005年所有革兰氏阴性菌的抗菌谱。根据世界卫生组织标准计算每种喹诺酮类药物的限定日剂量（DDD）。为了考虑患者数量的波动，计算了研究各年份的DDD/1000床日数。使用Pearson相关系数r评估每种喹诺酮类药物的DDD/1000床日数与革兰氏阴性菌对环丙沙星敏感性之间的关联。
在研究期间，共有48261份抗菌谱、347931个喹诺酮类药物的DDD以及1943338个床日。住院患者中喹诺酮类药物的使用量从2000年的237.2 DDD/1000床日降至2005年的115.2 DDD/1000床日。除产气肠杆菌外，在所评估的所有13种革兰氏阴性菌中，莫西沙星的使用与敏感性呈负相关（r = -0.07至-0.97）。当汇总所有革兰氏阴性菌的敏感性时，除莫西沙星外的所有喹诺酮类药物都与敏感性增加相关（r = 0.486至1.000），而莫西沙星与敏感性降低相关（r = -0.464）。
莫西沙星虽被用于社区获得性肺炎的经验性治疗，但可能对革兰氏阴性菌的局部抗生素敏感性产生重要负面影响。喹诺酮类药物的其他常用成员未出现这种效应。
