台湾粉尘爆炸事件中烧伤的健康年轻成年人身上多重耐药鲍曼不动杆菌的获得与清除：对抗菌药物管理的启示
Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship.
作者信息
Huang Po-Yen, Shie Shian-Sen, Ye Jung-Jr, Lin Shih-Pin, Liu Tsui-Ping, Wu Ting-Shu, Wu Tsu-Lan, Chuang Shiow-Shuh, Cheng Ming-Huei, Hsieh Yu-Chia, Huang Ching-Tai
机构信息
Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.
Infection Control Committee, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
出版信息
BMC Infect Dis. 2017 Aug 30;17(1):598. doi: 10.1186/s12879-017-2682-4.
BACKGROUND
Information is limited about the effect of restricted carbapenem use on clearance of multi-drug resistant Acinetobacter baumannii (MDRAB). We sought to determine the time effect of antibiotic exposure on multi-drug resistant Acinetobacter baumannii (MDRAB) acquisition and clearance.
METHODS
We conducted a retrospective observational study at the intensive care units of a tertiary medical center. Forty-two of a cohort of previously healthy young adults who were concurrently burned by a dust explosion was included. Cases consisted of those from whom MDRAB was isolated during hospitalization. Controls consisted of patients from whom MDRAB was not isolated in the same period. Use of antimicrobial agents was compared based on days of therapy per 1,000 patient-days (DOT/1,000PD). A 2-state Markov multi-state model was used to estimate the risk of acquisition and clearance of MDRAB.
RESULTS
MDRAB was discovered in 9/42 (21.4%) individuals. The cases had significantly higher use of carbapenem (652 DOT/1,000PD vs. 385 DOT/1,000PD, P < 0.001) before MDRAB isolation. For the cases, clearance of MDRAB was associated with lower use of carbapenem (469 DOT/1,000PD vs. 708 DOT/1,000PD, P = 0.003) and higher use of non-carbapenem beta-lactam (612 DOT/1,000PD vs. 246 DOT/1,000PD, P <0.001). In multi-state model, each additional DOT of carbapenem increased the hazard of acquiring MDRAB (hazard ratio (HR), 1.08; 95% confidence interval (CI) 1.01-1.16) and each additional DOT of non-carbapenem beta-lactam increased the protection of clearing MDRAB (HR, 1.25; 95% CI 1.07-1.46).
CONCLUSIONS
Both acquisition and clearance of MDRAB were related to antibiotic exposure in a homogeneous population. Our findings suggest that early discontinuation of carbapenem could be an effective measure in antibiotic stewardship for the control of MDRAB spreading.
背景
关于限制碳青霉烯类药物使用对多重耐药鲍曼不动杆菌（MDRAB）清除的影响，相关信息有限。我们试图确定抗生素暴露时间对多重耐药鲍曼不动杆菌（MDRAB）获得和清除的影响。
方法
我们在一家三级医疗中心的重症监护病房进行了一项回顾性观察研究。纳入了42名曾健康的年轻人，他们因粉尘爆炸同时烧伤。病例包括住院期间分离出MDRAB的患者。对照组包括同期未分离出MDRAB的患者。根据每1000患者日的治疗天数（DOT/1000PD）比较抗菌药物的使用情况。使用双状态马尔可夫多状态模型来估计MDRAB获得和清除的风险。
结果
9/42（21.4%）的个体发现了MDRAB。在分离出MDRAB之前，病例组碳青霉烯类药物的使用显著更高（652 DOT/1000PD对385 DOT/1000PD，P<0.001）。对于病例组，MDRAB的清除与碳青霉烯类药物使用减少（469 DOT/1000PD对708 DOT/1000PD，P = 0.003）和非碳青霉烯类β-内酰胺类药物使用增加（612 DOT/1000PD对246 DOT/1000PD，P<0.001）有关。在多状态模型中，碳青霉烯类药物每增加一个DOT会增加获得MDRAB的风险（风险比（HR），1.08；95%置信区间（CI）1.01-1.16），非碳青霉烯类β-内酰胺类药物每增加一个DOT会增加清除MDRAB的保护作用（HR，1.25；95%CI 1.07-1.46）。
结论
在同质人群中，MDRAB的获得和清除均与抗生素暴露有关。我们的研究结果表明，早期停用碳青霉烯类药物可能是抗生素管理中控制MDRAB传播的有效措施。
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