Ogutlu Aziz, Guclu Ertugrul, Karabay Oguz, Utku Aylin Calica, Tuna Nazan, Yahyaoglu Mehmet
Sakarya University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
Ann Clin Microbiol Antimicrob. 2014 Jan 9;13:7. doi: 10.1186/1476-0711-13-7.
The consumption of carbapenems has increased worldwide, together with the increase in resistant gram negative bacilli. Subsequently, the prevalence of carbapenem-resistant Acinetobacter infections has increased rapidly and become a significant problem particularly in intensive care unit patients. The aim of the present study was to evaluate the changes in the prevalence of Acinetobacter infection by restricting the consumption of carbapenems in intensive care unit patients.
This study was conducted between May 1, 2011 and February 28, 2013. The amount of carbapenem consumption and the number of patients with multi-drug resistant Acinetobacter baumannii (MDRAB) isolates during the study period were retrospectively obtained from the records of the patients, who were hospitalized in the intensive care unit. The study period was divided into two periods named as: Carbapenem non-restricted period (CNRP) and carbapenem-restricted period (CRP). During CNRP, no restrictions were made on the use of carbapenems. During CRP, the use of carbapenems was not allowed if there was an alternative to carbapenems. Primary Endpoint: MDRAB infection after ICU admission. The definition of nosocomial infections related to Acinetobacter spp. was based on the criteria of the Center for Disease Control (CDC). The correlation between the amount of carbapenem consumption and the number of infections with MDRAB strains between the two periods were evaluated.
During the study period, a total of 1822 patients' (1053 patients in CNRP and 769 patients in CRP) records were evaluated retrospectively. A total of 10.82 defined daily dose (DDD/100 ICU days) of anti-pseudomonal carbapenem were used in CNRP, and this figure decreased to 6.95 DDD/100 ICU days in CRP. In the 8-month CNRP, 42 (3.98%) MDRAB-related nosocomial infections were detected, and 14 (1.82%) infections were detected in CRP (p = 0.012).
The prevalence of MDRAB strains isolated in the CNRP was 2.24-fold higher than the prevalence in the CRP. The prevalence of Acinetobacter infections can be reduced by taking strict isolation measures as well as by implementing good antibiotics usage policy.
在全球范围内，碳青霉烯类药物的使用量随着革兰氏阴性耐药杆菌的增加而上升。随后，耐碳青霉烯类不动杆菌感染的患病率迅速上升，尤其在重症监护病房患者中成为一个重大问题。本研究的目的是通过限制重症监护病房患者碳青霉烯类药物的使用量来评估不动杆菌感染患病率的变化。
本研究于2011年5月1日至2013年2月28日进行。回顾性地从在重症监护病房住院患者的记录中获取研究期间碳青霉烯类药物的使用量以及多重耐药鲍曼不动杆菌（MDRAB）分离株患者的数量。研究期间分为两个阶段，即：碳青霉烯类药物非限制期（CNRP）和碳青霉烯类药物限制期（CRP）。在CNRP期间，对碳青霉烯类药物的使用不做限制。在CRP期间，如果有碳青霉烯类药物的替代药物，则不允许使用碳青霉烯类药物。主要终点：入住重症监护病房后发生的MDRAB感染。与不动杆菌属相关的医院感染的定义基于疾病控制中心（CDC）的标准。评估两个阶段之间碳青霉烯类药物使用量与MDRAB菌株感染数量之间的相关性。
在研究期间，共回顾性评估了1822例患者的记录（CNRP中有1053例患者，CRP中有769例患者）。在CNRP中，共使用了10.82限定日剂量（DDD/100个重症监护病房日）的抗假单胞菌碳青霉烯类药物，这一数字在CRP中降至6.95 DDD/100个重症监护病房日。在为期8个月的CNRP中，检测到42例（3.98%）与MDRAB相关的医院感染，在CRP中检测到14例（1.82%）感染（p = 0.012）。
在CNRP中分离出的MDRAB菌株的患病率比CRP中的患病率高2.24倍。采取严格的隔离措施以及实施良好的抗生素使用政策可以降低不动杆菌感染的患病率。
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