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目的肯塔基大学医院为减少第三代头孢菌素头孢噻肟和头孢他啶的应用以第四代头孢菌素头孢吡肟进行策略性换药,并对其进行了评价。方法对换药前及换药后各6个月的抗生素应用及细菌耐药性进行回顾性研究。研究包括所有住院患者发生的耐万古霉素肠球菌(VRE)、耐头孢他啶肺炎克雷伯菌(CRKP)、耐甲氧西林金黄色葡萄球菌(MRSA)、耐哌拉西林铜绿假单胞菌(PRPA)及耐头孢他啶铜绿假单胞菌(CRPA)感染。结果头孢他啶用量自其9600g减少至99g,头孢噻肟用量自6314g减少至732g,两者总用量共减少89％。头孢吡肟用量自0g增加至5396g。耐头孢他啶肺炎克雷伯菌感染自13％降低至3％,耐哌拉西林铜绿假单胞菌感染自22％降低至14％,耐头孢他啶铜绿假单胞菌感染自25％降低至15％(p值均小于0.05)。MRSA感染降低不明显,而VRE感染显著增多。结论以头孢吡肟替代头孢他啶或头孢噻肟,在减少头孢菌素用量的同时似可降低耐头孢他啶肺炎克雷伯菌、耐哌拉西林铜绿假单胞菌和耐头孢他啶铜绿假单胞菌感染的发生率。
Purpose The University of Kentucky Hospital, a third-generation cephalosporin cefotaxime and ceftazidime to reduce the application of the fourth-generation cephalosporin cefepime strategy for dressing, and its evaluation. Methods The antibiotic use and antibiotic resistance of 6 months before and after dressing change were retrospectively studied. The study included all patients with vancomycin-resistant enterococci (VRE), ceftazidime-resistant Klebsiella pneumonia (CRKP), methicillin-resistant Staphylococcus aureus (MRSA), P. aeruginosa ( PRPA) and ceftazidime resistant Pseudomonas aeruginosa (CRPA) infection. Results The dosage of ceftazidime decreased from 9600g to 99g, the dosage of cefotaxime decreased from 6314g to 732g, and the total amount of ceftazidime decreased by 89%. The amount of cefepime increased from 0g to 5396g. Ceftazidime-resistant K. pneumoniae infections decreased from 13% to 3%, P. aeruginosa resistance to piperacillin decreased from 22% to 14%, and ceftazidime-resistant Pseudomonas aeruginosa infections decreased from 25% to 15% ( p-value less than 0.05). MRSA infection was not significantly reduced, while VRE infection increased significantly. Conclusion Cefepime could replace ceftazidime or cefotaxime to reduce the amount of cephalosporins while reducing the resistance to ceftazidime-resistant Klebsiella pneumoniae, Pirarubicin-resistant Pseudomonas aeruginosa and ceftazidime-resistant Pseudomonas aeruginosa Occurrence rate.