Krediet T G, Fleer A, Gerards L J
Department of Neonatology and Medical Microbiology, University Children's Hospital, Het Wilhelmina Kinderziekenhuis, State University of Utrecht, The Netherlands.
J Hosp Infect. 1993 May;24(1):39-46. doi: 10.1016/0195-6701(93)90088-h.
A prospective study of the development of resistance to aminoglycosides among coagulase-negative staphylococci (CNS) and Enterobacteriaceae (ENT) was conducted for all patients admitted to a neonatal intensive care unit (NICU) from October 1985 to January 1990. A change in antibiotic regimen from gentamicin to amikacin occurred in January 1986, due to widespread gentamicin resistance among CNS, the most important cause of nosocomial infections in this NICU. From 657 patients, 884 faecal cultures, 1505 cultures from the respiratory tract and 152 blood cultures were included in the study. After its introduction, susceptibility to amikacin decreased rapidly in faecal and respiratory CNS isolates (from 62% to 28% and from 58% to 23% respectively). During the first half year, resistance to amikacin in faecal CNS isolates developed more rapidly among antibiotic-treated patients than among patients not treated with antibiotics. Susceptibility to amikacin in CNS blood isolates decreased more slowly, from 94% to 58% in 1987, while subsequently an increase in susceptibility was observed to about 80% in 1989. The same difference in development of resistance in faecal and respiratory CNS isolates compared to CNS blood isolates was noticed for gentamicin and tobramycin. In contrast, ENT remained highly (85-100%) susceptible to amikacin, gentamicin and tobramycin throughout the study period. It was concluded that four years after its introduction amikacin still appeared to be a valuable antibiotic in combination treatment of the vast majority of clinically important infections occurring in our NICU, since both Enterobacteriaceae and the majority of CNS blood isolates proved to be susceptible to this agent.(ABSTRACT TRUNCATED AT 250 WORDS)
对1985年10月至1990年1月入住新生儿重症监护病房（NICU）的所有患者进行了一项关于凝固酶阴性葡萄球菌（CNS）和肠杆菌科（ENT）对氨基糖苷类抗生素耐药性发展的前瞻性研究。由于CNS对庆大霉素广泛耐药，而这是该NICU医院感染的最重要原因，1986年1月抗生素治疗方案从庆大霉素改为阿米卡星。该研究纳入了657例患者的884份粪便培养物、1505份呼吸道培养物和152份血培养物。引入阿米卡星后，粪便和呼吸道CNS分离株对其敏感性迅速下降（分别从62%降至28%和从58%降至23%）。在上半年，接受抗生素治疗的患者中粪便CNS分离株对阿米卡星的耐药性发展比未接受抗生素治疗的患者更快。CNS血培养分离株对阿米卡星的敏感性下降较慢，1987年从94%降至58%，随后在1989年敏感性又升至约80%。庆大霉素和妥布霉素在粪便和呼吸道CNS分离株与CNS血培养分离株中的耐药性发展也存在同样差异。相比之下，在整个研究期间，ENT对阿米卡星、庆大霉素和妥布霉素仍具有高度敏感性（85%-100%）。得出的结论是，在引入阿米卡星四年后，它在联合治疗我们NICU中发生的绝大多数临床重要感染方面似乎仍是一种有价值的抗生素，因为肠杆菌科和大多数CNS血培养分离株对该药物敏感。（摘要截短至250字）
