氨基糖苷类耐药性监测。欧洲数据。

Surveillance of aminoglycoside resistance. European data.

作者信息

Van Landuyt H W, Boelaert J, Glibert B, Gordts B, Verbruggen A M

出版信息

Am J Med. 1986 Jun 30;80(6B):76-81. doi: 10.1016/0002-9343(86)90483-3.

Abstract

The susceptibility patterns of gram-negative aerobic organisms to aminoglycosides differ widely from one European health care center to another and depend upon local antibiotic prescribing policies. Reports of the susceptibility of Pseudomonas aeruginosa to gentamicin and tobramycin have ranged from as low as 49.8 percent and 77.7 percent, respectively, in Greece, to as high as 96.6 percent and 99.2 percent, respectively, in the United Kingdom. The susceptibility of P. aeruginosa to gentamicin, tobramycin, and amikacin decreased in our hospital from 73.1 percent, 94.8 percent, and 95.6 percent, respectively, in 1982, to 43.1 percent, 70.6 percent, and 74.3 percent, respectively, in 1984. A prospective surveillance study of the susceptibility of gram-negative aerobic bacilli to four aminoglycosides (gentamicin, tobramycin, amikacin, and netilmicin) was performed over a period of 17 months. Gentamicin and tobramycin were freely used, while the use of amikacin was restricted throughout the hospital during a four-month baseline period (May through August 1984). Gentamicin and tobramycin accounted for 94 percent of the aminoglycoside use. During the following 13 months (September 1984 through September 1985), amikacin was used as the first-line aminoglycoside and accounted for more than 97 percent of the aminoglycoside usage. A total of 1,866 organisms were analyzed during the baseline period; 5,429 were analyzed during the amikacin-usage period. The overall susceptibility to gentamicin, tobramycin, amikacin, and netilmicin increased from 86.9 percent, 90.4 percent, 94.2 percent, and 88.3 percent, respectively, to 92.3 percent, 94.0 percent, 97.3 percent, and 92.3 percent, respectively. P. aeruginosa isolates had the most striking changes, with the susceptibility to gentamicin, tobramycin, amikacin, and netilmicin increasing from 43.1 percent, 70.6 percent, 74.3 percent, and 50.6 percent, respectively, during the baseline period, to 64.5 percent, 81.6 percent, 90.8 percent, and 65.1 percent, respectively, during the amikacin-usage period. The use of amikacin as a first-line aminoglycoside, while use of the other aminoglycosides was restricted, seemed to have a favorable influence on the susceptibility pattern of gram-negative aerobic isolates in our hospital.

摘要

革兰氏阴性需氧菌对氨基糖苷类药物的药敏模式在欧洲的各个医疗中心之间差异很大，这取决于当地的抗生素处方政策。关于铜绿假单胞菌对庆大霉素和妥布霉素的药敏报告显示，在希腊，其药敏率分别低至49.8%和77.7%，而在英国则分别高达96.6%和99.2%。在我们医院，铜绿假单胞菌对庆大霉素、妥布霉素和阿米卡星的药敏率从1982年的73.1%、94.8%和95.6%分别降至1984年的43.1%、70.6%和74.3%。在17个月的时间里，对革兰氏阴性需氧杆菌对四种氨基糖苷类药物（庆大霉素、妥布霉素、阿米卡星和奈替米星）的药敏情况进行了前瞻性监测研究。在为期四个月的基线期（1984年5月至8月），庆大霉素和妥布霉素在全院可随意使用，而阿米卡星的使用受到限制。庆大霉素和妥布霉素占氨基糖苷类药物使用量的94%。在随后的13个月（1984年9月至1985年9月），阿米卡星被用作一线氨基糖苷类药物，占氨基糖苷类药物使用量的比例超过97%。在基线期共分析了1866株菌株；在阿米卡星使用期分析了5429株菌株。对庆大霉素、妥布霉素、阿米卡星和奈替米星的总体药敏率分别从86.9%、90.4%、94.2%和88.3%升至92.3%、94.0%、97.3%和92.3%。铜绿假单胞菌分离株的变化最为显著，其对庆大霉素、妥布霉素、阿米卡星和奈替米星的药敏率在基线期分别为43.1%、70.6%、74.3%和50.6%，在阿米卡星使用期分别升至64.5%、81.6%、90.8%和65.1%。将阿米卡星用作一线氨基糖苷类药物，同时限制其他氨基糖苷类药物的使用，似乎对我院革兰氏阴性需氧菌分离株的药敏模式产生了有利影响。