Kollef M H, Vlasnik J, Sharpless L, Pasque C, Murphy D, Fraser V
Department of Internal Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1040-8. doi: 10.1164/ajrccm.156.4.9701046.
The purpose of this study was to determine the impact of a scheduled change of antibiotic classes, used for the empiric treatment of suspected gram-negative bacterial infections, on the incidence of ventilator-associated pneumonia and nosocomial bacteremia. Six hundred eighty patients undergoing cardiac surgery were evaluated. During a 6-mo period (i.e., the before-period), our traditional practice of prescribing a third generation cephalosporin (ceftazidime) for the empiric treatment of suspected gram-negative bacterial infections was continued. This was followed by a 6-mo period (i.e., the after-period) during which a quinolone (ciprofloxacin) was used in place of the third-generation cephalosporin. The incidence of ventilator-associated pneumonia was significantly decreased in the after-period (n = 327) compared with the before-period (n = 353) (6.7 versus 11.6%; p = 0.028). This was primarily due to a significant reduction in the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria (0.9 versus 4.0%; p = 0.013). Similarly, we observed a lower incidence of bacteremia attributed to antibiotic-resistant gram-negative bacteria in the after-period compared with the before-period (0.3 versus 1.7%; p = 0.125). These data suggest that a scheduled change of antibiotic classes can reduce the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria.
本研究的目的是确定用于经验性治疗疑似革兰氏阴性菌感染的抗生素类别定期更换，对呼吸机相关性肺炎和医院获得性菌血症发生率的影响。对680例接受心脏手术的患者进行了评估。在一个6个月的时期（即前期），我们继续采用传统做法，使用第三代头孢菌素（头孢他啶）对疑似革兰氏阴性菌感染进行经验性治疗。随后是一个6个月的时期（即后期），在此期间使用喹诺酮类药物（环丙沙星）取代第三代头孢菌素。与前期（n = 353）相比，后期（n = 327）呼吸机相关性肺炎的发生率显著降低（6.7%对11.6%；p = 0.028）。这主要是由于耐抗生素革兰氏阴性菌所致呼吸机相关性肺炎的发生率显著降低（0.9%对4.0%；p = 0.013）。同样，我们观察到与前期相比，后期耐抗生素革兰氏阴性菌所致菌血症的发生率较低（0.3%对1.7%；p = 0.125）。这些数据表明，抗生素类别定期更换可降低耐抗生素革兰氏阴性菌所致呼吸机相关性肺炎的发生率。
