McGregor Jessina C, Dumyati Ghinwa, Casiano-Colón Aida E, Chang Pei-Jean, Klevens R Monina
Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
Diagn Microbiol Infect Dis. 2009 May;64(1):70-5. doi: 10.1016/j.diagmicrobio.2008.12.016. Epub 2009 Feb 26.
We assessed the impact of distributing an outpatient age-specific methicillin-resistant Staphylococcus aureus (MRSA) antibiogram on physician knowledge of MRSA prevalence and choice of empiric therapy. Questionnaires were given to 125 physicians at outpatient pediatric clinics in Monroe County, NY, before and after antibiogram distribution (response rates, 42% and 24%, respectively). The median physician-estimated MRSA prevalence (among S. aureus skin infections) was 15% before they received the antibiogram and 20% after. According to the antibiogram, the true 2005 prevalence was 25% among skin infections. When asked to select empiric therapy for a pediatric outpatient with a skin abscess, while assuming varying levels of MRSA prevalence, most selected cephalexin when the prevalence was assumed to be 20% or less, and trimethoprim-sulfamethoxazole when the prevalence was assumed to be 30% or greater. These data suggest that antibiograms may improve empiric therapy decision making by increasing knowledge of local outpatient prevalence of antibiotic resistance.
我们评估了分发一份针对门诊患者的按年龄划分的耐甲氧西林金黄色葡萄球菌（MRSA）抗菌谱对医生关于MRSA流行情况的了解以及经验性治疗选择的影响。在纽约州门罗县的门诊儿科诊所，在分发抗菌谱之前和之后，分别向125名医生发放了问卷（回复率分别为42%和24%）。在收到抗菌谱之前，医生估计的MRSA流行率（在金黄色葡萄球菌皮肤感染中）中位数为15%，之后为20%。根据抗菌谱，2005年皮肤感染中的实际流行率为25%。当被要求为一名患有皮肤脓肿的儿科门诊患者选择经验性治疗时，假设MRSA流行率处于不同水平，当假设流行率为20%或更低时，大多数人选择头孢氨苄，当假设流行率为30%或更高时，选择甲氧苄啶 - 磺胺甲恶唑。这些数据表明，抗菌谱可能通过增加对当地门诊抗生素耐药性流行情况的了解来改善经验性治疗决策。
