抗菌药物的使用方法与超广谱β-内酰胺酶控制之间的关系

Association of Antibiotic Utilization Measures with Control of Extended-spectrum β-1actamases

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摘要目的：探讨哌拉西林／他唑巴坦对减少产超广谱β-内酰胺酶（ESBL）大肠埃希菌或肺炎克雷伯菌定植的价值。方法：研究分为3个月的第Ⅰ阶段（干预前阶段）和6个月的第Ⅱ阶段（干预阶段），在干预前阶段，所有患者均按常规应用抗菌药物治疗各种感染。第Ⅱ阶段前3个月开始抗菌药物干预，所有感染患者推荐用哌拉西林／他唑巴坦治疗（替代3代头孢至少50．0％）。通过直肠拭子培养检查，用双纸片扩散法测定干预前阶段和干预后阶段（最后3个月）患者是否产ESBL的大肠埃希菌或肺炎克雷伯菌。结果：（1）总体上产ESBL的大肠埃希菌或肺炎克雷伯菌的获得率在干预前后从20．0％降至17．0％，但差异无统计学意义。（2）在社区产ESBL的大肠埃希菌或肺炎克雷伯菌呈高的获得率。结论：医院内干预前后产ESBL大肠埃希菌或肺炎克雷伯菌的获得率差异无统计学意义。 Objective：To determine the acquisition rate of ESBL-producing E. coli or K. pneumoniae, both pre- and post-intervention.To determine the value of using piperacillin/ tazobactam in reducing the cases of ESBL-producing E. coli or K. pneumoniae colonization and infection. Methods：The total duration of the study was 9 months. All patients admitted or transferred to the respiratory unit will be enrolled. This study had 3-month Phase Ⅰ （pre-intervention phase） period and 6-month Phase Ⅱ （intervention phase） period. In Pre-intervention Phase, Routine procedure for respiratory units was performed and the standard prescribed antibiotic was given to the patients with infection. After Intervention Period （First 3 Months）, Routine medical procedures were done. Piperacillin/tazobactam was the primary antibiotic used （ at least 50% replacement of ceftazidime ） . Patient underwent rectal swab for detection of ESBL and non-ESBL pathogens by double-disc diffusion within 48 hours before or after admission or discharge from the respiratory unit. Result：（1）However, the acquisition rate of ESBL-producing E. coli and K. Pneumoniae has only decreased from 20% to 17% with no significant statistical difference between preintervention and post- intervention. （2）h is apparent that the acquisition rate of ESBL-producing E. coli or K. pneumoniae was higher in community. Conelusiion： The aequisiton rate of ESBL-Producing E. Colin and K. Pneumoniae has no significant statisbical difference between-phase differences.

作者冯健倪松石吕学东贵素琴褚少朋 FENG Jian, NI Songshi, LV Xuedong, BEN Suqin,CHU Shaopeng~ （Department of Respiration; ~Departement of Laboratory Medicine, Affiliated Hospital of Nantong University, Jiangsu 226001 ）

机构地区南通大学附属医院呼吸内科南通大学附属医院检验科

出处《交通医学》 2008年第4期 369-370,377,共3页 Medical Journal of Communications

关键词超广谱β-内酰胺酰抗菌药物干预直肠拭子培养 extended-spectrum β-lactamases Antibiotic Intervention Rectal swab

分类号 R978.11 [医药卫生—药品][医药卫生—药学] R563.1 [医药卫生—呼吸系统][医药卫生—临床医学][医药卫生—内科学]

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