Røder B L, Nielsen S L, Magnussen P, Engquist A, Frimodt-Møller N
Department of Clinical Microbiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
J Antimicrob Chemother. 1993 Oct;32(4):633-42. doi: 10.1093/jac/32.4.633.
We report a study of antimicrobial use in patients admitted to the Intensive Care Unit (ICU) in a Danish university hospital during the course of 1 year. Of 615 patients admitted, 434 (71%) received antibiotics, 220 (36%) for infections and 222 (36%) for prophylaxis. Therapy for suspected infection accounted for 67% of the total consumption of antibiotics and prophylaxis for 33%. Ampicillin was the drug most frequently used; 43% of the patients treated for infection received this drug. One hundred and thirty-one patients (60%) were treated for suspected lower respiratory tract infection. Relevant microbiological specimens were obtained from 120 (92%) of these patients and a possible pathogen was isolated in 92 patients (77%, 92/120). Staphylococcus aureus and Streptococcus pneumoniae were each isolated in almost a quarter of the patients, and Enterobacteriaceae in 53%. However, many of the pathogens isolated were of no clinical relevance and merely reflected a state of colonization. Most treatments were given during the first few days following admission. Of 220 patients receiving antibiotics for an infection, 87% were treated on day 1, but only 34% (14 of 41) on day 11. The frequent use of laboratory investigations combined with good communication between clinicians and microbiologists probably resulted in rapid cessation of unnecessary therapy. Fifty-two per cent of the antibiotics given for prophylaxis were administered later than the first postoperative day. This study emphasizes the need for consultation between surgeons and clinical microbiologists to supervise postoperative antibiotic use.
我们报告了一项对丹麦一家大学医院重症监护病房（ICU）收治患者为期1年的抗菌药物使用情况研究。在615名收治患者中，434名（71%）接受了抗生素治疗，其中220名（36%）用于治疗感染，222名（36%）用于预防。疑似感染的治疗占抗生素总消耗量的67%，预防占33%。氨苄西林是最常用的药物；43%接受感染治疗的患者使用了该药。131名患者（60%）因疑似下呼吸道感染接受治疗。从其中120名（92%）患者获取了相关微生物标本，92名患者（77%，92/120）分离出可能的病原体。金黄色葡萄球菌和肺炎链球菌在近四分之一的患者中被分离出，肠杆菌科在53%的患者中被分离出。然而，许多分离出的病原体并无临床相关性，仅反映了定植状态。大多数治疗在入院后的头几天进行。在220名因感染接受抗生素治疗的患者中，87%在第1天接受治疗，但在第11天仅34%（41名中的14名）接受治疗。实验室检查的频繁使用以及临床医生与微生物学家之间良好的沟通可能导致不必要治疗的迅速停止。52%用于预防的抗生素在术后第一天之后给药。本研究强调外科医生与临床微生物学家之间进行会诊以监督术后抗生素使用的必要性。
