Turnbull Isaiah R, Buckman Sara A, Horn Christopher B, Bochicchio Grant V, Mazuski John E
Department of Surgery, Washington University School of Medicine , St. Louis, Missouri.
Surg Infect (Larchmt). 2018 Jan;19(1):40-47. doi: 10.1089/sur.2017.087. Epub 2017 Oct 13.
Antibiotic-impregnated central venous catheters (CVCs) decrease the incidence of infection in high-risk patients. However, use of these catheters carries the hypothetical risk of inducing antibiotic resistance. We hypothesized that routine use of minocycline and rifampin-impregnated catheters (MR-CVC) in a single intensive care unit (ICU) would change the resistance profile for Staphylococcus aureus.
We reviewed antibiotic susceptibilities of S. aureus isolates obtained from blood cultures in a large urban teaching hospital from 2002-2015. Resistance patterns were compared before and after implementation of MR-CVC use in the surgical ICU (SICU) in August 2006. We also compared resistance patterns of S. aureus obtained in other ICUs and in non-ICU patients, in whom MR-CVCs were not used.
Data for rifampin, oxacillin, and clindamycin were available for 9,703 cultures; tetracycline resistance data were available for 4,627 cultures. After implementation of MR-CVC use in the SICU, rifampin resistance remained unchanged, with rates the same as in other ICU and non-ICU populations (3%). After six years of use of MR-CVCs in the SICU, the rate of tetracycline resistance was unchanged in all facilities (1%-3%). The use of MR-CVCs was not associated with any change in S. aureus oxacillin-resistance rates in the SICU (66% vs. 60%). However, there was a significant decrease in S. aureus clindamycin resistance (59% vs. 34%; p < 0.05) in SICU patients.
Routine use of rifampin-minocycline-impregnated CVCs in the SICU was not associated with increased resistance of S. aureus isolates to rifampin or tetracyclines.
抗生素浸渍中心静脉导管（CVC）可降低高危患者的感染发生率。然而，使用这些导管存在诱导抗生素耐药性的潜在风险。我们假设在单一重症监护病房（ICU）常规使用米诺环素和利福平浸渍导管（MR-CVC）会改变金黄色葡萄球菌的耐药谱。
我们回顾了2002年至2015年在一家大型城市教学医院从血培养中分离出的金黄色葡萄球菌的抗生素敏感性。比较了2006年8月外科ICU（SICU）实施MR-CVC使用前后的耐药模式。我们还比较了在未使用MR-CVC的其他ICU和非ICU患者中获得的金黄色葡萄球菌的耐药模式。
有9703份培养物可获得利福平、苯唑西林和克林霉素的数据；4627份培养物可获得四环素耐药数据。在SICU实施MR-CVC使用后，利福平耐药性保持不变，其发生率与其他ICU和非ICU人群相同（3%）。在SICU使用MR-CVC六年之后，所有机构中四环素耐药率均未改变（1%-3%）。在SICU中，MR-CVC的使用与金黄色葡萄球菌苯唑西林耐药率的任何变化均无关（66%对60%）。然而，SICU患者中金黄色葡萄球菌克林霉素耐药性显著降低（59%对34%；p<0.05）。
在SICU常规使用利福平-米诺环素浸渍CVC与金黄色葡萄球菌分离株对利福平或四环素的耐药性增加无关。
