扭转重症监护病房的抗菌药物耐药趋势：抗菌药物管理和诊断管理的作用
Reversing the Trend of Antimicrobial Resistance in ICU: Role of Antimicrobial and Diagnostic Stewardship.
作者信息
Agarwal Jyotsna, Singh Vikramjeet, Das Anupam, Nath Soumya S, Kumar Rajeev, Sen Manodeep
机构信息
Department of Microbiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Anaesthesiology and Critical Care, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
出版信息
Indian J Crit Care Med. 2021 Jun;25(6):635-641. doi: 10.5005/jp-journals-10071-23861.
BACKGROUND
Increasing antimicrobial resistance (AMR) among common bacteria combined with the slow development of new antibiotics has posed a challenge to clinicians.
AIM AND OBJECTIVE
To demonstrate whether antimicrobial and diagnostic stewardship program (ASP and DSP)-related interventions improve antibiotic susceptibilities among common bacteria causing bloodstream infections (BSI) in patients admitted to the intensive care unit (ICU) and whether these resulted in changes in the volume of antimicrobial consumption.
MATERIALS AND METHODS
We compared the susceptibility patterns of gram-negative bacteria (GNB) and gram-positive cocci (GPC) causing BSI and changes in the volume of antibiotics prescribed for the same before and after 2017 by a retrospective analysis.
RESULTS
Postintervention, there was increased susceptibility of all GNBs to aminoglycosides; and spp. to beta-lactambeta-lactamase inhibitors (BLBLI) combinations; and spp. and spp. to carbapenems. spp., spp., and spp. showed improved susceptibility to doxycycline, whereas and spp. showed significantly improved susceptibility to fluoroquinolones. Among GPCs, there was increased susceptibility of (levofloxacin, clindamycin, and aminoglycoside), coagulase-negative (CoNS) (chloramphenicol, levofloxacin, clindamycin, and aminoglycoside), and enterococci (chloramphenicol, levofloxacin, and clindamycin). There was a significant reduction in usage of antimicrobials for the treatment of GPCs (linezolid, doxycycline, chloramphenicol, levofloxacin, BLBLI, macrolide, and cephalosporin) and GNBs (levofloxacin, cephalosporin, carbapenem, and colistin), which caused BSI.
CONCLUSION
The present study illustrated that combined ASP and DSP interventions successfully reversed the resistance pattern of organisms causing BSI and resulted in a reduction in antibiotic utilization.
HOW TO CITE THIS ARTICLE
Agarwal J, Singh V, Das A, Nath SS, Kumar R, Sen M. Reversing the Trend of Antimicrobial Resistance in ICU: Role of Antimicrobial and Diagnostic Stewardship. Indian J Crit Care Med 2021;25(6):635-641.
背景
常见细菌的抗菌药物耐药性（AMR）不断增加，加上新型抗生素研发缓慢，给临床医生带来了挑战。
目的
证明抗菌和诊断管理计划（ASP和DSP）相关干预措施是否能提高重症监护病房（ICU）住院患者中引起血流感染（BSI）的常见细菌的抗生素敏感性，以及这些措施是否会导致抗菌药物使用量的变化。
材料与方法
我们通过回顾性分析，比较了2017年前后引起BSI的革兰氏阴性菌（GNB）和革兰氏阳性球菌（GPC）的药敏模式以及针对它们所开具的抗生素使用量的变化。
结果
干预后，所有GNB对氨基糖苷类药物的敏感性增加； 菌属对β-内酰胺/β-内酰胺酶抑制剂（BLBLI）组合的敏感性增加； 菌属和 菌属对碳青霉烯类药物的敏感性增加。 菌属、 菌属和 菌属对多西环素的敏感性提高，而 菌属和 菌属对氟喹诺酮类药物的敏感性显著提高。在GPC中， （左氧氟沙星、克林霉素和氨基糖苷类）、凝固酶阴性葡萄球菌（CoNS）（氯霉素、左氧氟沙星、克林霉素和氨基糖苷类）和肠球菌（氯霉素、左氧氟沙星和克林霉素）的敏感性增加。用于治疗引起BSI的GPC（利奈唑胺、多西环素、氯霉素、左氧氟沙星、BLBLI、大环内酯类和头孢菌素）和GNB（左氧氟沙星、头孢菌素、碳青霉烯类和黏菌素）的抗菌药物使用量显著减少。
结论
本研究表明，ASP和DSP联合干预成功扭转了引起BSI的微生物的耐药模式，并导致抗生素使用量减少。
如何引用本文
Agarwal J, Singh V, Das A, Nath SS, Kumar R, Sen M. Reversing the Trend of Antimicrobial Resistance in ICU: Role of Antimicrobial and Diagnostic Stewardship. Indian J Crit Care Med 2021;25(6):635 - 641.
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