限制使用三代头孢菌素可降低感染相关病死率  

Restriction of third-generation cephalosporin use decreases infection-related mortality.

作　　者：杜斌[1] 陈德昌[1] 刘大为[1] 隆云[1] 石岩[1] 王郝[1] 芮曦[1] 崔娜[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院加强医疗科,100730

出　　处：《中国实用外科杂志》2004年第6期348-351,共4页Chinese Journal of Practical Surgery

摘　　要：目的　研究限制使用三代头孢菌素对细菌耐药性及感染病人预后的影响。方法　 2 0 0 0年 1月至2 0 0 1年 12月 ,前瞻性研究在大学附属教学医院的综合性加强医疗病房 (ICU)中进行 ,2年内所有收入ICU的病人均入选。在第 2年开始采用新的抗生素治疗策略 ,怀疑或确诊革兰阴性杆菌感染的所有病人均使用三代头孢菌素以外的其他抗生素进行治疗。对比 2年间常见的革兰阴性杆菌耐药性及感染病人住院死亡率。结果　与第1年相比 ,第 2年中三代头孢菌素的用量下降 2 6 6 % [从每月 (16 8 2± 4 8 0 ) g下降至 (12 3 5± 39 3) g ,P =0 0 2 1],头孢吡肟用量增加 2 77 7% [从每月 (10 3± 19 2 )g增加至 (38 9± 31 7) g ,P =0 0 14 ]。同期革兰阴性杆菌对三代头孢菌素的耐药率呈显著下降 (P <0 0 5 ) ,其中以大肠埃希菌和克雷伯菌属的耐药性下降最为显著(P <0 0 5 )。第 2年间感染相关的病死率显著降低 (19 3%vs 36 3% ,P =0 0 14 )。多因素逻辑回归分析表明 ,下呼吸道感染、免疫功能抑制和持续静脉静脉血液滤过是增加感染相关病死率的独立危险因素 (P <0 0 5 ) ,而大肠埃希菌或克雷伯菌属感染 (P =0 0 39)和限制使用三代头孢菌素 (P =0 0 2 5 )与病死率降低密切相关。结论　在危重病限制使用三代头孢菌素?Objectives To determine the effect of restriction of third-generation cephalosporin use on antibiotic resistance and the outcome of patients with infection. Methods From January 2000 to December 2001, a prospective,study was performed in a general intensive care unit at the university affiliated teaching hospital. All patients admitted to ICU within 2 years were included in the study. A new antibiotic treatment strategy was implemented during phase II. All patients with confirmed or suspected Gram-negative bacterial infections were treated mainly with antibiotics other than third-generation cephalosporins. Antibiotic resistance among common Gram-negative bacilli and infection-related hospital mortality during phase I were compared with phase II. Results A 26.6% reduction in third-generation cephalosporin use (from 168.2±48.0 to 123.5±39.3 grams per month, P =0.021), accompanied by a 277.7% increase in cefepime use (from 10.3±19.2 to 38.9±31.7 grams per month, P=0.014) occurred in phase II compared with phase I. This was accompanied by a significant decrease in reduced susceptibility of Gram-negative bacilli to third-generation cephalosporins (P<0.05), mainly due to the improved susceptibility of Escherichia coli and Klebsiella spp. (P<0.05). Infection-related hospital mortality was significantly lower in phase II (19.3% vs 36.3%, P=0.014). Multiple logistic regression analysis demonstrated lower respiratory tract infection, the status of immunocompromise, and continuous venous-venous hemofiltration as independent risk factors for infection-related hospital mortality (P<0.05), while infection with E. coli or Klebsiella spp. (P=0.039) and restriction of third-generation cephalosporin use (P=0.025) were associated with significantly lower mortality rate. Conclusion Restriction of third-generation cephalosporin use may improve the antibiotic susceptibility and reduce infection-related hospital mortality in critically ill patients.

关 键 词：限制性用药 头孢菌素 感染 病死率 耐药性 

分 类 号：R978.11[医药卫生—药品] R63[医药卫生—药学]