Rahal J J, Urban C, Horn D, Freeman K, Segal-Maurer S, Maurer J, Mariano N, Marks S, Burns J M, Dominick D, Lim M
Department of Medicine, New York Hospital Medical Center of Queens and Cornell University Medical College, Flushing 11355, USA. cmurban%
JAMA. 1998 Oct 14;280(14):1233-7. doi: 10.1001/jama.280.14.1233.
Resistance to most or all cephalosporin antibiotics in Klebsiella species has developed in many European and North American hospitals during the past 2 decades.
To determine if restriction of use of the cephalosporin class of antibiotics would reduce the incidence of patient infection or colonization by cephalosporin-resistant Klebsiella.
A before-after comparative 2-year trial.
A 500-bed, university-affiliated community hospital in Queens, NY.
All adult medical and surgical hospital inpatients.
A new antibiotic guideline excluded the use of cephalosporins except for pediatric infection, single-dose surgical prophylaxis, acute bacterial meningitis, spontaneous bacterial peritonitis, and outpatient gonococcal infection. All other cephalosporin use required prior approval by the infectious disease section.
Incidence of patient infection or colonization by ceftazidime-resistant Klebsiella during 1995 (control period) compared with 1996 (intervention period).
An 80.1% reduction in hospital-wide cephalosporin use occurred in 1996 compared with 1995. This was accompanied by a 44.0% reduction in the incidence of ceftazidime-resistant Klebsiella infection and colonization throughout the medical center (P<.01), a 70.9% reduction within all intensive care units (P<.001), and an 87.5% reduction within the surgical intensive care unit (P<.001). A concomitant 68.7% increase in the incidence of imipenem-resistant Pseudomonas aeruginosa occurred throughout the medical center (P<.01). All such isolates except one were susceptible to other antibiotics.
Extensive cephalosporin class restriction significantly reduced nosocomial, plasmid-mediated, cephalosporin-resistant Klebsiella infection and colonization. This occurred at the price of increased imipenem resistance in P aeruginosa, which remained susceptible to other agents. Thus, an overall reduction in multiply-resistant pathogens was achieved within 1 year.
在过去20年里，许多欧洲和北美的医院中，肺炎克雷伯菌对大多数或所有头孢菌素类抗生素产生了耐药性。
确定限制使用头孢菌素类抗生素是否会降低耐头孢菌素肺炎克雷伯菌引起的患者感染或定植的发生率。
一项前后对比的2年试验。
纽约皇后区一家拥有500张床位的大学附属医院。
所有成年内科和外科住院患者。
一项新的抗生素指南规定，除儿科感染、单剂量手术预防、急性细菌性脑膜炎、自发性细菌性腹膜炎和门诊淋球菌感染外，禁止使用头孢菌素。所有其他头孢菌素的使用都需要感染病科事先批准。
1995年（对照期）与1996年（干预期）相比，耐头孢他啶肺炎克雷伯菌引起的患者感染或定植的发生率。
与1995年相比，1996年全院头孢菌素的使用量减少了80.1%。与此同时，整个医疗中心耐头孢他啶肺炎克雷伯菌感染和定植的发生率降低了44.0%（P<0.01），所有重症监护病房内降低了70.9%（P<0.001），外科重症监护病房内降低了87.5%（P<0.001）。整个医疗中心耐亚胺培南铜绿假单胞菌的发生率相应增加了68.7%（P<0.01）。除1株外，所有此类分离株对其他抗生素敏感。
广泛限制头孢菌素类药物的使用显著降低了医院内由质粒介导的耐头孢菌素肺炎克雷伯菌的感染和定植。这是以铜绿假单胞菌对亚胺培南耐药性增加为代价实现的，而该菌对其他药物仍敏感。因此，在1年内实现了多重耐药病原体总体数量的减少。
