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-lactamases

作　　者：冯健[1] 倪松石[1] 吕学东[1] 贲素琴[1] 褚少朋[2] 

机构地区：[1]南通大学附属医院呼吸内科,江苏226001 [2]南通大学附属医院检验科,江苏226001

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

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.

关 键 词：超广谱β-内酰胺酰 抗菌药物干预 直肠拭子培养 

分 类 号：R978.11[医药卫生—药品] R563.1[医药卫生—药学]