通过抗生素管理和感染控制计划成功控制中国大学医院多重耐药铜绿假单胞菌的发生率。
Successfully controlling the incidence of multidrug-resistant Pseudomonas aeruginosa through antibiotic stewardship and infection control programmes at a Chinese university hospital.
机构信息
Department of Geriatrics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
出版信息
J Clin Pharm Ther. 2021 Oct;46(5):1357-1366. doi: 10.1111/jcpt.13446. Epub 2021 Jun 6.
WHAT IS KNOWN AND OBJECTIVE
The purpose of this study was to investigate the effect of imposing infection control programmes (ICPs) and antimicrobial stewardship (AMS) by monitoring the antimicrobial resistance of Pseudomonas aeruginosa.
METHODS
Antimicrobial susceptibility testing was performed in accordance with the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. ICPs and AMS were initiated at the Fourth Hospital from 2013 to 2018.
RESULTS AND DISCUSSION
A total of 2,886 P. aeruginosa isolates were assessed. The antimicrobial resistance trends of the P. aeruginosa strains improved after the intervention measures. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) P. aeruginosa contributed to 18.5% and 3.5% of the total P. aeruginosa strains, respectively. Colistin was the most effective antibiotic against 97.6% of XDR-P. aeruginosa and 99.41% of MDR-P. aeruginosa. The consumption of alcohol-based hand gel (ABHG) increased from 0.6 L to 10.8 L per 1,000 patient-days (PD) (p = 0.005). The yearly consumption of antibiotics decreased from 45 to 37.5 defined daily doses (DDD) per 1,000 PD(p = 0.04). After 2013, the incidence rate of MDR-P. aeruginosa showed a significant decrease from 22% to 14.1% (p = 0.04), and XDR-P. aeruginosa decreased from 5.8% to 0.9%. The use of ABHG was negatively related to MDR-P. aeruginosa morbidity (r = -0.86; p = 0.021). The consumption of antibiotics was positively related to MDR-P. aeruginosa morbidity (r = 0.86; p = 0.021).
WHAT IS NEW AND CONCLUSION
Successful control of MDR-P. aeruginosa resistance was achieved by imposing comprehensive ICPs and AMS.
已知和目的
本研究的目的是通过监测铜绿假单胞菌的抗菌药物耐药性来研究实施感染控制方案（ICPs）和抗菌药物管理（AMS）的效果。
方法
根据临床和实验室标准协会和欧洲抗菌药物敏感性试验委员会的指南进行抗菌药物敏感性试验。2013 年至 2018 年期间，第四医院开始实施 ICP 和 AMS。
结果和讨论
共评估了 2886 株铜绿假单胞菌。干预措施后，铜绿假单胞菌菌株的抗菌药物耐药趋势有所改善。多重耐药（MDR）和广泛耐药（XDR）铜绿假单胞菌分别占总铜绿假单胞菌菌株的 18.5%和 3.5%。多粘菌素对 97.6%的 XDR-P. 铜绿假单胞菌和 99.41%的 MDR-P. 铜绿假单胞菌最有效。酒精基手凝胶（ABHG）的消耗量从每千名患者每天 0.6 升增加到 10.8 升（p=0.005）。每年抗生素的消耗量从 45 个到 37.5 个定义的每日剂量（DDD）每千名患者每天减少（p=0.04）。2013 年后，MDR-P. 铜绿假单胞菌的发病率从 22%显著下降到 14.1%（p=0.04），XDR-P. 铜绿假单胞菌从 5.8%下降到 0.9%。ABHG 的使用与 MDR-P. 铜绿假单胞菌发病率呈负相关（r=-0.86；p=0.021）。抗生素的消耗与 MDR-P. 铜绿假单胞菌发病率呈正相关（r=0.86；p=0.021）。
创新与结论
通过实施全面的 ICP 和 AMS，成功控制了 MDR-P. 铜绿假单胞菌的耐药性。
Zotero 插件