Evans Heather L, Sawyer Robert G
Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA 98104-2499, USA.
Surg Clin North Am. 2009 Apr;89(2):501-19, x. doi: 10.1016/j.suc.2008.09.011.
The development of antimicrobial resistant pathogens in surgical patients is a significant problem, and infections caused by these organisms are associated with increased morbidity and mortality. Programs to prevent the spread of resistant organisms emphasize standard infection control practices and appropriate antibiotic prescribing practices. Antibiotic restriction and selective reporting of bacterial susceptibilities have had limited success in decreasing development of resistance, and are difficult to maintain effectively in the absence of widespread clinician acceptance. Potentially more promising are integrated decision support tools, which can support optimal antibiotic selection while preserving the sense of clinician autonomy. The use of antibiotic cycling programs for critically ill patients may be another approach to preserving the efficacy of the currently antimicrobial against the continued pressure of increasing bacterial resistance.
手术患者中抗菌药物耐药病原体的出现是一个重大问题，这些病原体引起的感染与发病率和死亡率增加相关。预防耐药菌传播的项目强调标准的感染控制措施和适当的抗生素处方做法。抗生素限制和细菌药敏结果的选择性报告在降低耐药性发展方面取得的成功有限，并且在缺乏临床医生广泛接受的情况下难以有效维持。可能更有前景的是综合决策支持工具，其可以支持最佳抗生素选择，同时保留临床医生的自主权。对重症患者使用抗生素轮换方案可能是另一种应对细菌耐药性不断增加的持续压力、维持当前抗菌药物疗效的方法。
