Betts R F, Valenti W M, Chapman S W, Chonmaitree T, Mowrer G, Pincus P, Messner M, Robertson R
Ann Intern Med. 1984 Feb;100(2):219-22. doi: 10.7326/0003-4819-100-2-219.
Because an increased incidence of nosocomial bacteremia due to gentamicin-resistant organisms occurred in our hospital, amikacin was substituted for gentamicin as the primary empiric aminoglycoside. Prospective surveillance of aminoglycoside use and of bacterial resistance to aminoglycosides was done before and after the substitution. We compared the baseline period when gentamicin was the primary aminoglycoside with the subsequent period when amikacin accounted for 81% of aminoglycoside used. During the two periods the patient population did not differ with regard to indications for aminoglycoside therapy. Among the gram-negative organisms isolated, rates of amikacin resistance during the baseline (1.1%) and usage (1.05%) periods were not significantly different (p greater than 0.6). Resistance to gentamicin and tobramycin during the period of amikacin use showed a statistically significant decrease (p greater than 0.001) due to decreased resistance to gentamicin of Providencia, Serratia, indole-positive Proteus, and decreased resistance to tobramycin of Pseudomonas aeruginosa. Unrestricted use of amikacin does not necessarily lead to increase in amikacin resistance but may lead to a decrease in resistance to gentamicin and tobramycin among gram-negative organisms.
由于我院耐庆大霉素的医院获得性菌血症发病率增加，阿米卡星替代庆大霉素作为主要的经验性氨基糖苷类药物。在替代前后对氨基糖苷类药物的使用情况及细菌对氨基糖苷类药物的耐药性进行了前瞻性监测。我们将以庆大霉素为主要氨基糖苷类药物的基线期与随后阿米卡星占氨基糖苷类药物使用量81%的时期进行了比较。在这两个时期，氨基糖苷类药物治疗的适应证方面患者群体没有差异。在分离出的革兰阴性菌中，基线期（1.1%）和使用期（1.05%）的阿米卡星耐药率无显著差异（p>0.6）。在使用阿米卡星期间，对庆大霉素和妥布霉素的耐药性出现统计学显著下降（p>0.001），这是由于普罗威登斯菌属、沙雷菌属、吲哚阳性变形杆菌对庆大霉素的耐药性降低，以及铜绿假单胞菌对妥布霉素的耐药性降低。无限制使用阿米卡星不一定会导致阿米卡星耐药性增加，但可能会导致革兰阴性菌对庆大霉素和妥布霉素的耐药性降低。
