Curcio D
Instituto Sacre Couer and Hospital Municipal Chivilcoy, Argentina.
Ann Med Health Sci Res. 2013 Apr;3(2):220-8. doi: 10.4103/2141-9248.113666.
It is widely acknowledged that the presence of infection is an important outcome determinant for intensive care unit (ICU) patients. In fact, antibiotics are one of the most common therapies administered in the ICU settings.
To evaluate the current usage of antibiotics in Latin American ICUs.
A one-day p-oint prevalence study to investigate the patterns of antibiotic was undertaken in 72 Latin American (LA) ICUs. Data was analyzed using the Statistix 8 statistical software, version 2.0 (USA). Results were expressed as proportions. When applicable, two tailed hypothesis testing for difference in proportions was used (Proportion Test); a P value of <0.05 was considered significant.
Of 704 patients admitted, 359 received antibiotic treatment on the day of the study (51%), of which 167/359 cases (46.5%) were due to hospital-acquired infections. The most frequent infection reorted was nosocomial pneumonia (74/359, 21%). Only in 264/359 patients (73.5%), cultures before starting antibiotic treatment were performed. Thirty-eight percent of the isolated microorganisms were Enterobacteriaceae extended-spectrum β-lactamase-producing, 11% methicillin-resistant Staphylococcus aureus and 10% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (125/359, 35%), alone or in combination with vancomycin or other antibiotic. There were no significant differences in the "restricted" antibiotic prescription (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, fluoroquinolones, tigecycline and linezolid) between patients with APACHE II score at the beginning of the antibiotic treatment <15 [83/114 (72.5%)] and ≥15 [179/245 (73%)] (P = 0.96). Only 29% of the antibiotic treatments were cultured directed (104/359).
Carbapenems (alone or in combination) were the most frequently prescribed antibiotics in LA ICUs. However, the problem of carbapenem resistance in LA requires that physicians improve the use of this class of antibiotics. Our findings show that our web-based method for collection of one-day point prevalence was implemented successfully. However, based on the limitations of the model used, the results of this study must be taken with caution.
感染的存在是重症监护病房（ICU）患者重要的预后决定因素，这一点已得到广泛认可。事实上，抗生素是ICU环境中最常用的治疗方法之一。
评估拉丁美洲ICU中抗生素的当前使用情况。
在72家拉丁美洲（LA）ICU开展了一项为期一天的现患率研究，以调查抗生素的使用模式。使用美国Statistix 8统计软件2.0版对数据进行分析。结果以比例表示。在适用的情况下，使用比例差异的双侧假设检验（比例检验）；P值<0.05被认为具有统计学意义。
在704例入院患者中，359例（51%）在研究当天接受了抗生素治疗，其中167/359例（46.5%）是由于医院获得性感染。报告最常见的感染是医院获得性肺炎（74/359，21%）。仅264/359例患者（73.5%）在开始抗生素治疗前进行了培养。分离出的微生物中，38%是产超广谱β-内酰胺酶的肠杆菌科细菌，11%是耐甲氧西林金黄色葡萄球菌，10%是耐碳青霉烯类非发酵革兰阴性菌。最常开具的抗生素是碳青霉烯类（125/359，35%），单独使用或与万古霉素或其他抗生素联合使用。在抗生素治疗开始时急性生理与慢性健康状况评分系统（APACHE II）<15分的患者[83/114（72.5%）]和≥15分的患者[179/245（73%）]之间，“限制使用”的抗生素处方（碳青霉烯类、万古霉素、哌拉西林-他唑巴坦、广谱头孢菌素、氟喹诺酮类、替加环素和利奈唑胺）没有显著差异（P = 0.96）。仅29%的抗生素治疗是根据培养结果进行的（104/359）。
碳青霉烯类（单独或联合使用）是拉丁美洲ICU中最常开具的抗生素。然而，拉丁美洲碳青霉烯类耐药问题要求医生改善这类抗生素的使用。我们的研究结果表明，我们基于网络的一天现患率收集方法成功实施。然而，基于所用模型的局限性，本研究结果必须谨慎对待。
