Møller J K
Institute of Medical Microbiology, University of Aarhus.
Dan Med Bull. 1990 Jun;37(3):263-74.
Hospital infections continue to be an important problem. Changes in patient categories and in the examinations and treatments offered at the hospital, probably constitute the basis upon which new types of infections and new groups of infecting microorganisms continually emerge. The treatment of patients with hospital infections may become complicated by the emergence of drug resistance in the infecting microorganisms. The situation varies between hospitals, and this necessitates a local microbiological monitoring. Prerequisites of a surveillance system in general are described and illustrated by a system monitoring antimicrobial resistance in a Danish county. A specific computer system (software) for the processing of clinical microbiological results was developed by the author to make the local microbiological monitoring possible. Computer-assisted analyses for an evaluation of the statistical association of drug resistance traits (phenotype) were also developed. Data on local drug resistance patterns were systematically obtained and analysed in a seven-year study comprising several hundred thousands specimens. Drug resistance genotypes were determined for selected groups of microorganisms (e.g. coagulase-negative staphylococci) in various periods. Data from these studies emphasize that it is important to correlate information about resistance phenotypes of all clinical isolates with the resistance genotypes of selected strains in the monitoring of plasmid mediated resistance and its dissemination. These findings agree well with the results of other but generally less comprehensive studies in the literature. In a study of outpatients treated with a particular antimicrobial (tetracycline), it was shown that this drug selected for plasmid mediated multiple drug resistance in the normal flora of the patients. On the basis of these results and the literature, a general model for the emergence and spread of antimicrobial drug resistance is discussed. Examinations of quantitative relationships between antimicrobial usage and microbial resistance are also reviewed. Analysis of the statistical correlation between various measures of antimicrobial use and the prevalence of microbial resistance in the Danish county corroborates the observation that general changes in prevalence of a particular resistance trait seem to be best explained by taking the mechanisms of co-selection by other antimicrobials into consideration.
医院感染仍然是一个重要问题。患者类别以及医院所提供的检查和治疗的变化，可能构成新类型感染和新的感染微生物群体不断出现的基础。医院感染患者的治疗可能会因感染微生物出现耐药性而变得复杂。不同医院的情况各不相同，这就需要进行当地的微生物监测。本文描述了一般监测系统的先决条件，并以丹麦一个郡监测抗菌药物耐药性的系统为例进行说明。作者开发了一个用于处理临床微生物学结果的特定计算机系统（软件），以使当地的微生物监测成为可能。还开发了用于评估耐药性状（表型）统计关联的计算机辅助分析方法。在一项为期七年、包含数十万份标本的研究中，系统地获取并分析了当地耐药模式的数据。在不同时期确定了选定微生物群体（如凝固酶阴性葡萄球菌）的耐药基因型。这些研究的数据强调，在监测质粒介导的耐药性及其传播时，将所有临床分离株的耐药表型信息与选定菌株的耐药基因型相关联非常重要。这些发现与文献中其他但通常不太全面的研究结果非常吻合。在一项针对使用特定抗菌药物（四环素）治疗的门诊患者的研究中，结果表明该药物在患者正常菌群中选择了质粒介导的多重耐药性。基于这些结果和文献，讨论了抗菌药物耐药性出现和传播的一般模型。还综述了对抗菌药物使用与微生物耐药性之间定量关系的研究。对丹麦该郡抗菌药物使用的各种衡量指标与微生物耐药性流行率之间的统计相关性分析证实了这样的观察结果：特定耐药性状流行率的总体变化似乎最好通过考虑其他抗菌药物的共同选择机制来解释。
