目的分析外科重症监护室(surgical intensive care unit,SICU)中限制性使用三代头孢菌素的临床疗效。方法回顾性对照研究。收集复旦大学附属中山医院SICU自2004年4月至2005年3月(Ⅰ组-对照组)和2005年4月至2006年3月(Ⅱ组-干预组)收治...目的分析外科重症监护室(surgical intensive care unit,SICU)中限制性使用三代头孢菌素的临床疗效。方法回顾性对照研究。收集复旦大学附属中山医院SICU自2004年4月至2005年3月(Ⅰ组-对照组)和2005年4月至2006年3月(Ⅱ组-干预组)收治的患者,对Ⅱ组实施限制性使用三代头孢菌素策略。比较两组SICU中临床诊断为肺部感染患者的痰培养结果,了解该策略对革兰阴性杆菌、革兰阳性球菌、真菌检出率的影响;对照两组间治疗性抗革兰阳性球菌和抗真菌药物的累计使用数量;统计两组总体死亡率和感染相关死亡率。结果两组的一般情况,包括患者的性别构成、平均年龄、APACHEⅡ评分、以及SICU治疗时间方面均无统计学差异。两组中肺部感染患者痰标本中革兰阴性多重耐药菌的检出率分别为23.1%和20.2%(P=0.192);耐甲氧西林的金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)的检出率分别为24.8%和15.9%(P=0.000);真菌的检出率分别为10.0%和4.8%(P=0.000);治疗性抗革兰阳性球菌及抗真菌药物用量明显降低;Ⅱ组中患者的感染相关病死率显著低于Ⅰ组。结论SICU中限制性使用三代头孢菌素策略未能显著降低肺部感染患者多重耐药革兰阴性杆菌在痰标本中的检出率,但有助于减少MRSA和真菌引起的感染,降低临床感染相关病死率,改善预后。展开更多
Background:Urinary tract infections(UTIs)are among the most common bacterial infections worldwide and have become more difficult to treat over the years.Inappropriate antibiotic use has led to increased antibiotic res...Background:Urinary tract infections(UTIs)are among the most common bacterial infections worldwide and have become more difficult to treat over the years.Inappropriate antibiotic use has led to increased antibiotic resistance.Materials and methods:We examined 1921 urine culture samples from a single hospital and analyzed them for bacterial spectrum and antibiotic susceptibility.We further analyzed changes in the rates of detected bacteria and of the sensitivity of these uropathogens to antibiotics over the years.Results:In our hospital-based analysis,cystitis was the most frequently diagnosed UTI in women(76%)and men(79%).Escherichia coli(48%)was the most commonly identified uropathogen.Samples demonstrated an increase in the proportion of E.coli(p<0.001)and a decrease in Enterococcus faecalis(p<0.001)over the study time period.Antimicrobial susceptibility analysis showed an increase over time in the number of isolates with resistance to ampicillin/sulbactam(p<0.001)and to third-generation cephalosporins cefotaxime(p=0.043)and ceftazidime(p<0.001).Conclusions:Ampicillin/sulbactam and third-generation cephalosporins are antibiotics frequently used in the treatment of UTIs.When selecting an optimal antimicrobial treatment regimen for patients with UTIs,it is imperative to understand regional and timedependent differences in the prevalence of various uropathogens and antimicrobial resistance patterns.Therefore,continuous surveillance of local pathogen and antimicrobial susceptibility patterns for frequently used antibiotics should be prioritized.展开更多
文摘Background:Urinary tract infections(UTIs)are among the most common bacterial infections worldwide and have become more difficult to treat over the years.Inappropriate antibiotic use has led to increased antibiotic resistance.Materials and methods:We examined 1921 urine culture samples from a single hospital and analyzed them for bacterial spectrum and antibiotic susceptibility.We further analyzed changes in the rates of detected bacteria and of the sensitivity of these uropathogens to antibiotics over the years.Results:In our hospital-based analysis,cystitis was the most frequently diagnosed UTI in women(76%)and men(79%).Escherichia coli(48%)was the most commonly identified uropathogen.Samples demonstrated an increase in the proportion of E.coli(p<0.001)and a decrease in Enterococcus faecalis(p<0.001)over the study time period.Antimicrobial susceptibility analysis showed an increase over time in the number of isolates with resistance to ampicillin/sulbactam(p<0.001)and to third-generation cephalosporins cefotaxime(p=0.043)and ceftazidime(p<0.001).Conclusions:Ampicillin/sulbactam and third-generation cephalosporins are antibiotics frequently used in the treatment of UTIs.When selecting an optimal antimicrobial treatment regimen for patients with UTIs,it is imperative to understand regional and timedependent differences in the prevalence of various uropathogens and antimicrobial resistance patterns.Therefore,continuous surveillance of local pathogen and antimicrobial susceptibility patterns for frequently used antibiotics should be prioritized.
