Schentag J J
Department of Pharmacy and Pharmaceutics, State University of New York, Buffalo.
Clin Ther. 1993;15 Suppl A:29-36.
Increasing resistance to ceftazidime and some other beta-lactam antibiotics developed among Enterobacter species after use of ceftazidime increased at a 500-bed community teaching hospital. Severe restrictions on the use of ceftazidime were imposed by pharmacy intervention. For empiric therapy of severe infections, a combination of tobramycin plus piperacillin was most frequently substituted for ceftazidime. Susceptibility patterns of Enterobacter returned to baseline within 3 months after active intervention reduced use of ceftazidime by 98% of its peak. There was no development of enhanced resistance to tobramycin or piperacillin or to other antibiotics on the formulary. It is concluded that active pharmacy intervention resulted in reversion of susceptibility of Enterobacter species to baseline for ceftazidime and the other beta-lactam antibiotics (ie, aztreonam, cefotaxime, ceftriaxone, mezlocillin, and piperacillin) for which covariance (ie, parallel decline of organisms' sensitivities) or cross-resistance had developed.
在一家拥有500张床位的社区教学医院，使用头孢他啶后，肠杆菌属对头孢他啶和其他一些β-内酰胺类抗生素的耐药性有所增加。通过药房干预，对头孢他啶的使用进行了严格限制。对于严重感染的经验性治疗，最常使用妥布霉素加哌拉西林的联合用药替代头孢他啶。在积极干预使头孢他啶的使用量降至峰值的98%后3个月内，肠杆菌属的药敏模式恢复到基线水平。对妥布霉素、哌拉西林或处方中的其他抗生素未出现增强耐药性。得出的结论是，积极的药房干预使肠杆菌属对头孢他啶和其他β-内酰胺类抗生素（即氨曲南、头孢噻肟、头孢曲松、美洛西林和哌拉西林）的药敏恢复到基线水平，这些抗生素已出现协变（即微生物敏感性平行下降）或交叉耐药。
