Hanberger H, Garcia-Rodriguez J A, Gobernado M, Goossens H, Nilsson L E, Struelens M J
Department of Infectious Diseases, University Hospital, Linköping, Sweden.
JAMA. 1999 Jan 6;281(1):67-71. doi: 10.1001/jama.281.1.67.
Surveillance of antibiotic resistance is especially important in intensive care units (ICUs) because the infection rates are much higher there than in other hospital wards and most epidemics with multiresistant bacteria originate in ICUs.
To evaluate the incidence of decreased antibiotic susceptibility among aerobic gram-negative bacilli isolated from patients in ICUs.
Consecutive specimens collected on clinical indications from ICU patients were cultured and tested. Minimum inhibitory concentrations for amikacin, ceftazidime, ceftriaxone, ciprofloxacin, gentamicin, imipenem, piperacillin, and piperacillin-tazobactam were determined using E test.
Eighteen hospitals in Belgium, 40 in France, 20 in Portugal, 30 in Spain, and 10 in Sweden.
A total of 9166 gram-negative strains were initially isolated from 7308 patients between June 1994 and June 1995.
The incidence of decreased susceptibility, defined as the sum of resistant and intermediate categories with use of the minimum inhibitory concentration break points recommended by the National Committee for Clinical Laboratory Standards.
The most frequently isolated organisms were Enterobacteriaceae (59%) followed by Pseudomonas aeruginosa (24%). The main sources were respiratory tract (42%), urine (26%), blood (14%), abdomen (11%), and skin and soft tissue (7%). Decreased antibiotic susceptibility across all species and drugs was highest in Portuguese ICUs followed by French, Spanish, Belgian, and Swedish ICUs. The highest incidence of resistance was seen in all countries among P aeruginosa (up to 37% resistant to ciprofloxacin in Portuguese ICUs and 46% resistant to gentamicin in French ICUs), Enterobacter species, Acinetobacter species, and Stenotrophomonas maltophilia, and in Portugal and France among Klebsiella species.
The high incidence of reduced antibiotic susceptibility among gram-negative bacteria in these ICUs suggests that more effective strategies are needed to control the selection and spread of resistant organisms.
重症监护病房（ICU）的抗生素耐药性监测尤为重要，因为那里的感染率远高于其他医院病房，而且大多数多重耐药菌引起的疫情都起源于ICU。
评估从ICU患者中分离出的需氧革兰氏阴性杆菌抗生素敏感性降低的发生率。
根据临床指征从ICU患者中连续采集标本进行培养和检测。使用E试验测定阿米卡星、头孢他啶、头孢曲松、环丙沙星、庆大霉素、亚胺培南、哌拉西林和哌拉西林-他唑巴坦的最低抑菌浓度。
比利时18家医院、法国40家医院、葡萄牙20家医院、西班牙30家医院和瑞典10家医院。
1994年6月至1995年6月期间，共从7308例患者中最初分离出9166株革兰氏阴性菌。
敏感性降低的发生率，定义为使用美国国家临床实验室标准委员会推荐的最低抑菌浓度断点时耐药和中介类别之和。
最常分离出的微生物是肠杆菌科（59%），其次是铜绿假单胞菌（24%）。主要来源是呼吸道（42%）、尿液（26%）、血液（14%）、腹部（11%）以及皮肤和软组织（7%）。所有物种和药物的抗生素敏感性降低在葡萄牙ICU中最高，其次是法国、西班牙、比利时和瑞典的ICU。在所有国家中，铜绿假单胞菌（在葡萄牙ICU中对环丙沙星耐药率高达37%；在法国ICU中对庆大霉素耐药率为46%）、肠杆菌属、不动杆菌属、嗜麦芽窄食单胞菌以及在葡萄牙和法国的克雷伯菌属耐药率最高。
这些ICU中革兰氏阴性菌抗生素敏感性降低的发生率很高，这表明需要更有效的策略来控制耐药菌的选择和传播。
