Thabet Lamia, Memmi Monia, Turki Amel, Messadi Amen Allah
Tunis Med. 2010 May;88(5):297-300.
Fluoroquinolones (FQ) use has been identified as a risk factor for colonization and infection to methicillin resistant Staphylococcus aureus(MRSA), Pseudomonas aeruginosae multiresistant(PMR) , Acinetobacter multiresistant (AMR) and multidrug resistant bacteria(MDRB).
Our study proposes to measure the annual antibiotic use of FQ and antimicrobial resistance in P. aeruginosa, S. aureus, Klebsiella pneumoniae and A. baumannii in an intensive care burn unit.
The study was conducted during a 4 year period (1 January 2000 to 31 December 2003). Antimicrobial susceptibility testing was performed using the disk diffusion method as recommended by the French Society of Microbiology. The consumption of the following antibiotics: ofloxacin, ciprofloxacin was expressed as the antimicrobial use density (AD) taking into account the quantity of antibiotics in Grams converted to defined daily doses (DDD) and the number of day hospitalization. Statistical significance was defined as p value < 0.05 for the corresponding correlation coefficient.
There were statistically significant relationship between use of ciprofloxacin and resistance in P. aeruginosa to this drug (rs=0.95, p<0.05). Moreover, the ciprofloxacin consumption was correlated with resistance to imipenem (rs=0.95, p<0.05) and ceftazidime (rs=0.95, p<0.05) in P. aeruginosa . A restriction use of ciprofloxacin has been taken during 2003, it is followed by a significant decrease of resistance to imipenem, ceftazidime and ciprofloxacin in P. aeruginosa (p<0, 05). The use of fluoroquinolones was correlated significantly with MRSA (rs=0.96, P<0.05) . The restriction use of FQ was significantly associated with a decrease of MRSA. The consumption of ciprofloxacin was also correlated (P<0.05) with resistance of ceftazidime in K. pneumoniae. However, there is not a correlation (P> 0.05) between fluoroquinolones use and resistance in A. baumannii as well in ciprofloxacin, imipenem and ceftazidime. Our study illustrates the pressure of selection of fluoroquinolones use in the development of MDRB. The use and or the duration of treatment with theses antibiotics should be rationalised as part of efforts to control the emergence of multidrug resistant bacteria.
氟喹诺酮类药物（FQ）的使用已被确认为耐甲氧西林金黄色葡萄球菌（MRSA）、多重耐药铜绿假单胞菌（PMR）、多重耐药不动杆菌（AMR）和多重耐药菌（MDRB）定植和感染的危险因素。
我们的研究旨在测量重症监护烧伤病房中FQ的年度抗生素使用情况以及铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌和鲍曼不动杆菌的耐药性。
该研究在4年期间（2000年1月1日至2003年12月31日）进行。按照法国微生物学会的建议，采用纸片扩散法进行药敏试验。以下抗生素的使用量：氧氟沙星、环丙沙星，以抗菌药物使用密度（AD）表示，即将抗生素的克数换算为限定日剂量（DDD）并考虑住院天数。相应相关系数的统计学显著性定义为p值<0.05。
环丙沙星的使用与铜绿假单胞菌对该药物的耐药性之间存在统计学显著关系（rs = 0.95，p < 0.05）。此外，铜绿假单胞菌中环丙沙星的使用量与对亚胺培南（rs = 0.95, p < 0.05）和头孢他啶（rs = 0.95, p < 0.05）的耐药性相关。2003年对环丙沙星采取了限制使用措施，随后铜绿假单胞菌对亚胺培南、头孢他啶和环丙沙星的耐药性显著下降（p < 0.05）。氟喹诺酮类药物的使用与MRSA显著相关（rs = 0.96, P < 0.05）。限制使用FQ与MRSA的减少显著相关。环丙沙星的使用量也与肺炎克雷伯菌对头孢他啶的耐药性相关（P < 0.05）。然而，氟喹诺酮类药物的使用与鲍曼不动杆菌以及环丙沙星、亚胺培南和头孢他啶的耐药性之间没有相关性（P > 0.05）。我们的研究说明了氟喹诺酮类药物使用在MDRB产生过程中的选择压力。作为控制多重耐药菌出现的努力的一部分，应合理使用这些抗生素及其治疗持续时间。
