一个抗生素政策,以防止出现耐药细菌
P de Man1, B A Verhoeven, H A Verbrugh
1Department of Medical Microbiology and Infection Control, Erasmus University Medical Centre, Rotterdam, The Netherlands. peter_de_man@franciscus.nl
Lancet (London, England)
|April 18, 2000
概括
在新生儿重症监护室 (NICU) 修改抗生素策略可以降低抗菌素耐药性. 避免使用阿莫西西林和塞福胺显著降低了新生儿耐药细菌殖民的风险.
科学领域:
- 新生儿重症监护室新生儿重症监护室
- 传染病流行病学 传染病流行病学
- 抗微生物药物管理管理
背景情况:
- 新生儿重症监护病房 (NICU) 经常因感染恐惧而经验上使用广谱抗生素,无意中促进了抗生素耐药性.
- 研究替代抗生素方案至关重要,以减轻有利于耐药细菌菌株的选择性压力.
研究的目的:
- 评估不同实证抗生素方案对NICU中抗菌素耐药性出现的影响.
- 确定修改抗生素策略是否可以阻止耐药细菌菌株的发展.
主要方法:
- 一项涉及两个相同的NICU的比较研究,每个被分配不同的经验抗生素方案用于新生儿败血症.
- 治疗方案在六个月后在单位之间切换;每周收集直肠和呼吸道培养物.
- 抗生素治疗方案包括青素G/托布拉米辛或流西林/托布拉米辛 (A单元) 与阿莫西西林/塞福塔克西姆 (B单元).
主要成果:
- 与青素-托布拉米辛疗法 (3 个新生儿) 相比,阿莫西西林-塞福塔克西姆疗法与耐药细菌 (41 个新生儿) 的殖民率明显更高.
- 耐药菌株殖民的相对风险是每1000个患者日的18倍,与阿莫西西林-塞福他西姆治疗方案.
- 出现了特定的细菌模式:Enterobacter cloacae 主导的是阿莫西西林-塞福胺,而大肠杆菌主导的是青素-托布拉米.
结论:
- 经验性抗生素政策极大地影响了新生儿重症监护室中抗菌素耐药性的控制.
- 避免使用阿莫西西林和塞福胺的疗法有效地限制了抗生素耐药性问题的发展.
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