School of Medicine, Universidade Federal do Rio Grande do Sul, Pharmacy Department and Hospital Infection Control Committee, Hospital de Clínicas de Porto Alegre, Brazil.
J Hosp Infect. 2010 May;75(1):23-7. doi: 10.1016/j.jhin.2009.11.021. Epub 2010 Mar 24.
We performed a 30-month ecological study to determine the impact of hospital-wide antibiotic consumption, invasive procedure use and hospital-acquired infections (HAIs) on antibiotic resistance in an intensive care unit (ICU). Microbiological isolates from ICU patients with established diagnosis of hospital infection were monitored throughout the study. Overall hospital consumption per 100 patient-days of piperacillin-tazobactam, fluoroquinolones and cephalosporins increased from 1.9 to 2.3 defined daily doses (DDD) (P<0.01), from 4.7 to 10.3 DDD (P<0.01) and from 12.1 to 16.4 DDD (P<0.01), respectively. Bacterial multiresistance in ICU was identified in 31.3% (N=466) of isolates, with increasing resistance demonstrated for meropenem-resistant Klebsiella spp. (P=0.01) and meropenem-resistant Acinetobacter spp. (P=0.02). There was a positive correlation between multiresistance rate and DDD of cephalosporins (P<0.01) and fluoroquinolones (P=0.03). The rate of ceftazidime-resistant Klebsiella spp. correlated with DDD of fluoroquinolones and cephalosporins; the rate of ceftazidime-resistant Pseudomonas spp. correlated with consumption of cephalosporins, and rate of meticillin-resistant Staphylococcus aureus (MRSA) correlated with fluoroquinolone use. During the studied period, 36.9% (P<0.001) and 34.5% (P<0.01) of the changing multiresistance rate in ICU was associated with use of invasive procedures and overall HAI rate, respectively. Multiresistance rates in ICU are influenced by the variation in overall HAI rate, hospital-wide invasive procedures and antibiotic consumption outside the ICU.
我们进行了一项为期 30 个月的生态学研究，以确定医院范围内抗生素的使用、侵袭性操作和医院获得性感染（HAI）对重症监护病房（ICU）中抗生素耐药性的影响。在整个研究过程中，监测了确诊为医院感染的 ICU 患者的微生物分离株。ICU 患者每 100 个患者日的哌拉西林他唑巴坦、氟喹诺酮类和头孢菌素的总消耗量从 1.9 增加到 2.3 个限定日剂量（DDD）（P<0.01），从 4.7 增加到 10.3 DDD（P<0.01），从 12.1 增加到 16.4 DDD（P<0.01）。ICU 中发现细菌多重耐药性在 31.3%（N=466）的分离株中，耐美罗培南的肺炎克雷伯菌（P=0.01）和耐美罗培南的不动杆菌（P=0.02）的耐药性增加。多重耐药率与头孢菌素（P<0.01）和氟喹诺酮类（P=0.03）的 DDD 呈正相关。头孢他啶耐药肺炎克雷伯菌的发生率与氟喹诺酮类和头孢菌素的 DDD 相关；头孢他啶耐药铜绿假单胞菌的发生率与头孢菌素的使用相关，耐甲氧西林金黄色葡萄球菌（MRSA）的发生率与氟喹诺酮类的使用相关。在研究期间，36.9%（P<0.001）和 34.5%（P<0.01）的 ICU 中不断变化的多重耐药率分别与侵袭性操作的使用和总体 HAI 率相关。ICU 中的多重耐药率受总体 HAI 率、医院范围内侵袭性操作和 ICU 外抗生素使用的变化影响。
