Pallares R, Dick R, Wenzel R P, Adams J R, Nettleman M D
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242.
Infect Control Hosp Epidemiol. 1993 Jul;14(7):376-82. doi: 10.1086/646765.
Antimicrobials are a major part of hospital pharmacy budgets and must be considered in resource planning and spending projections. Logically, trends in antimicrobial usage should be linked to trends in resistant pathogens.
To examine long-term trends in antimicrobial use over a 15-year period (1978 to 1992) and contrast them with changes in pathogens causing nosocomial bacteremia.
A 900-bed, tertiary care teaching hospital.
Pharmacy records were reviewed to identify parenteral antimicrobial agents administered to adult inpatients. Results were expressed in average daily adult doses per 1,000 patient days.
Chloramphenicol use decreased, while use of penicillin G, antistaphylococcal penicillins, first-generation cephalosporins, and aminoglycosides remained relatively stable. In contrast, there was a sharp increase in the use of second- and third-generation cephalosporins (7-fold and 6.5-fold increase, respectively), vancomycin (161-fold increase), metronidazole (32-fold increase) and amphotericin B (35-fold increase). The proportion of nosocomial bacteremias due to methicillin-resistant gram-positive bacteria rose, but gentamicin resistance in gram-negatives remained at low levels. During the past 14 years, the percentage of patients receiving at least one parenteral antimicrobial rose from 23% to 44%. Among patients receiving antimicrobials, the average number of different agents used per patient increased from 1.8 to 2.1.
If newer agents were available, use of older agents usually declined. If newer alternatives were not available, use of older agents rose sharply. The increased use of antimicrobials in adults was related to the expanded proportion of patients receiving these agents.
抗菌药物是医院药房预算的主要组成部分，在资源规划和支出预测中必须予以考虑。从逻辑上讲，抗菌药物使用趋势应与耐药病原体趋势相关联。
研究15年期间（1978年至1992年）抗菌药物使用的长期趋势，并将其与引起医院感染性菌血症的病原体变化进行对比。
一家拥有900张床位的三级护理教学医院。
查阅药房记录，以确定给予成年住院患者的肠外抗菌药物。结果以每1000个患者日的平均每日成人剂量表示。
氯霉素的使用量减少，而青霉素G、抗葡萄球菌青霉素、第一代头孢菌素和氨基糖苷类药物的使用量保持相对稳定。相比之下，第二代和第三代头孢菌素（分别增加7倍和6.5倍）、万古霉素（增加161倍）、甲硝唑（增加32倍）和两性霉素B（增加35倍）的使用量急剧增加。耐甲氧西林革兰氏阳性菌引起的医院感染性菌血症比例上升，但革兰氏阴性菌对庆大霉素的耐药性仍处于低水平。在过去14年中，接受至少一种肠外抗菌药物治疗的患者比例从23%上升至44%。在接受抗菌药物治疗的患者中，每位患者使用的不同药物平均数量从1.8增加到2.1。
如果有更新的药物可用，旧药物的使用通常会减少。如果没有更新的替代药物，旧药物的使用会急剧增加。成人抗菌药物使用量的增加与接受这些药物治疗的患者比例扩大有关。
