McGowan J E
Rev Infect Dis. 1983 Nov-Dec;5(6):1033-48. doi: 10.1093/clinids/5.6.1033.
Organisms causing nosocomial infection are frequently resistant to antimicrobial agents. Studies of the reasons for this have been hindered by difficulties in defining terms, by selection biases, by artifacts produced by study methods, and by failure to control for confounding variables. Major factors leading to increased prevalence of resistant organisms in hospitals are changes in organisms causing nosocomial infection (due in part to changes in characteristics of hospital populations and in procedures and instruments used in patient care), increasing prevalence of resistance in bacteria causing community-acquired infection, and use of antimicrobial agents. A causal relationship between antibiotic usage and resistance of hospital organisms is supported by consistent association and concurrent variation in several populations, presence of a dose-response pattern, and existence of a reasonable biologic model to explain the relationship. Major influences on emergence of resistant hospital bacteria include antimicrobial effects in treated individuals, mechanisms for transfer of resistance between bacteria, and routes of transmission within the hospital for bacteria or their resistance factors. Barrier isolation techniques can help control resistant hospital bacteria. However, virtually all reports agree that careful, discriminating use of antimicrobial agents remains the keystone for minimizing this problem. This need must be communicated more effectively to prescribers.
引起医院感染的微生物常常对抗菌药物耐药。对此类原因的研究受到诸多因素的阻碍，包括术语定义困难、选择偏倚、研究方法产生的人为因素以及未能控制混杂变量。导致医院中耐药微生物患病率增加的主要因素包括引起医院感染的微生物的变化（部分归因于医院人群特征以及患者护理中使用的程序和器械的变化）、社区获得性感染细菌耐药性患病率的增加以及抗菌药物的使用。抗生素使用与医院微生物耐药性之间的因果关系得到了几个人群中一致关联和同时变化、剂量反应模式的存在以及解释这种关系的合理生物学模型的支持。对耐药医院细菌出现的主要影响包括治疗个体中的抗菌作用、细菌之间耐药性转移机制以及医院内细菌或其耐药因子的传播途径。屏障隔离技术有助于控制耐药医院细菌。然而，几乎所有报告都一致认为，谨慎、有区别地使用抗菌药物仍然是将这个问题降至最低的关键。必须更有效地向开处方者传达这一需求。
