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Antibiotic therapy in surgery

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CHIRURG 1998年第12期69卷 1392-1398页

作者： Zimmerli, W Univ Kliniken Kantonsspital Abt Infektiol Dept Innere Med CH-4031 Basel Switzerland

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Enterococcal infections in a Greek intensive care unit: A 5-y study

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SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2000年第3期32卷 275-280页

作者： Routsi, C Platsouka, E Paniara, O Dimitriadou, E Saroglou, G Roussos, C Armaganidis, A Evangelismos Hosp Dept Clin Microbiol Athens Greece Evangelismos Hosp Dept Internal Med Athens Greece Univ Athens Sch Med Dept Crit Care GR-11527 Athens Greece

In this study we determined the incidence, resistance pattern, and mortality rate associated with infection caused by Enterococcus faecalis and Enterococcus faecium among patients in a multidisciplinary intensive care unit (ICU), A total of 111 patients with E, faecalis and 60 with E, faecium infections were identified during a 5-y period (1992-96), We observed an increase in the incidence of enterococcal infections (from 5.46 to 8.46 per 1000 patients-days, p = 0.0112), due mainly to the increased incidence of E, faecium (from 0.45 to 4.06 per 1000 patients-days, p = 0.002). Blood was the most common site of enterococcus isolation. E, faecium was more resistant to antibiotics than E, faecalis, but no vancomycin resistant enterococcus was isolated. Patients with E, faecium infection had a significantly higher mortality than patients with E, faecalis infection (66% vs. 41.5%, p = 0.0035 for infection from any site and 85.7 vs, 47.7%, p = 0.012 for bacteremic patients).

关键词：交叉感染/药物疗法交叉感染/流行病学抗药性微生物粪肠球菌/药物作用屎肠球菌/药物作用革兰氏阳性菌感染/药物疗法革兰氏阳性菌感染/流行病学希腊发病率重症监护病房/统计学和数值数据微生物敏感性试验存活率分析青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Trends in antibiotic use and cost and influence of case-mix and infection rate on antibiotic-prescribing in a long-term care facility

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AMERICAN JOURNAL OF INFECTION CONTROL 2003年第1期31卷 18-25页

作者： Mylotte, JM Neff, M SUNY Buffalo Sch Med & Biomed Sci Dept Med Buffalo NY 14260 USA SUNY Buffalo Sch Med & Biomed Sci Dept Microbiol Buffalo NY 14260 USA Cunningham Fahey Facil Loretto Residential Hlth Care Syracuse NY USA

Background: Antibiotic use and cost indicators have been developed specifically for the long-term care facility (LTCF) setting. Approximately 50% of the variation in these indicators was explained by the variation in infection rate. The objectives of this study were to further assess the utility of the antibiotic use and cost indicators in a different LTCF and to determine the correlation of case-mix and these indicators. Methods: Antibiotic use and cost indicators were collected monthly by unit (N = 10) and by physician (N = 6) at a 433-bed LTCF in Syracuse, New York, from February 1999 to September 2001. Indicators included incidence (number of antibiotic courses per 1000 resident care-days) of antibiotic use, antibiotic utilization ratio ([AUR];ratio of the number of antibiotic-days to the number of resident care-days), cost per antibiotic-day, and cost per resident care-day. Case-mix variation was measured with the case-mix index (CMI) of the Resource Utilization Group II system. Simple linear and multilinear regression analyses were used to evaluate correlations of continuous variables. Results: Among the 10 units or 6 physicians, there was a significant difference in the average values for all indicators. Correlation between unit- or physician-specific CMI and antibiotic use or cost indicators or infection rate was poor. However, there was a significant positive correlation between unit- or physician-specific infection rate and incidence of antibiotic use, AUR, and cost per resident care-day but not cost per antibiotic-day. With use of multilinear regression analysis to control for CMI and cost per antibiotic-day, infection rate was a significant predictor of incidence of antibiotic use (R-2 = 0.65;P < .001) and AUR (R-2 = 0.78;P < .001). Conclusions. This study provides further evidence that the antibiotic use and cost indicators developed specifically for LTCFs can detect significant variation among units within a facility and among physicians. However, ther

关键词：抗菌药/经济学抗菌药/治疗应用交叉感染/药物疗法交叉感染/经济学交叉感染/流行病学诊断相关患者组药费支出药物利用评审卫生保健费用感染控制/经济学线性模型多元分析纽约/流行病学医护疗养所/经济学医护疗养所/统计学和数值数据医师诊疗模式/统计学和数值数据前瞻性研究人类

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Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第3期30卷 170-173页

作者： Morel, AS Wu, F Della-Latta, P Cronquist, A Rubenstein, D Saiman, L Columbia Univ New York Presbyterian Hosp Dept Pediat Div Infect Dis New York NY USA Columbia Univ New York Presbyterian Hosp Div Neonatal New York NY USA Columbia Univ New York Presbyterian Hosp Clin Microbiol Lab New York NY USA Columbia Univ New York Presbyterian Hosp Dept Epidemiol New York NY USA

Background: Patient-to-patient transmission of methicillin-resisiant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs) has been well described. We report the first documented outbreak of probable transmission of MRSA from a mother to 3 of her preterm quadruplet infants postnatally. Methods: Routine surveillance of clinical microbiologic laboratory reports revealed an increased incidence of MRSA infections in our NICU, including 3 of 4 preterm quadruplets. Surveillance cultures of the anterior nares of all patients and the quadruplets' parents were performed to detect MRSA carriage. The isolates were typed by pulsed-field gel electrophoresis with the restriction endonuclease SmaI. Infection control strategies included mupirocin treatment and contact isolation precautions for infected/colonized infants. Results: Clinical cultures from infants A. C, and D and surveillance cultures of the quadruplets' mother and 2 additional unrelated infants grew the same clone of MRSA. The mother's only identified risk factors for MRSA acquisition were 2 prepartum hospitalizations related to the multiple gestation and previous treatment with antibiotics. All anterior nares cultures were negative for MRSA after mupirocin treatment. Conclusions. Use of gowns and gloves by the family members of women with multiple gestations should be recommended to prevent transmission of potential pathogens in the NICU.

关键词：氨基酸序列带病原状态交叉感染/药物疗法交叉感染/流行病学交叉感染/微生物学交叉感染/传播疾病暴发流行电泳凝胶脉冲场婴儿早产疾病/药物疗法婴儿早产疾病/微生物学感染控制重症监护病房新生儿甲氧西林抗药性莫匹罗星/治疗应用妊娠并发症/微生物学四胎葡萄球菌感染/药物疗法葡萄球菌感染/传播葡萄球菌金黄色/分离和提纯成年人女(雌)性人类婴儿新生妊娠

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Nosocomial pneumococcal infection: An outbreak

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HOSPITAL PRACTICE 1999年第10期34卷 77-+页

作者： Leggiadro, RJ NYU Sch Med Dept Pediat New York NY 10012 USA

When an outbreak of pneumococcal disease occurs an institution-be it a hospital, nursing home, day care center, or other facility-management includes treatment of affected cases and prevention of new cases, Patients and staff should be tested for nasopharyngeal carriage and their vaccination status ascertained. Antibiotic use should be reviewed, especially if the causative strain is resistant.

关键词：算法细菌菌苗交叉感染/药物疗法交叉感染/流行病学交叉感染/微生物学交叉感染/预防和控制疾病暴发流行/预防和控制医护疗养所青霉素抗药性肺炎肺炎球菌性/药物疗法肺炎肺炎球菌性/流行病学肺炎肺炎球菌性/预防和控制老年人老年人 80以上人类男(雄)性

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Ability of laboratories to detect emerging antimicrobial resistance in nosocomial pathogens: a survey of Project ICARE laboratories

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DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE 2000年第1期38卷 59-67页

作者： Steward, CD Wallace, D Hubert, SK Lawton, R Fridkin, SK Gaynes, RP McGowan, JE Tenover, FC Ctr Dis Control & Prevent Hosp Infect Program Atlanta GA 30333 USA Emory Univ Rollins Sch Publ Hlth Atlanta GA 30322 USA

A proficiency testing project was conducted among 48 microbiology laboratories participating in Project ICARE Intensive Care Antimicrobial Resistance Epidemiology). All laboratories correctly identified the Staphylococcus aureus challenge strain as oxacillin-resistant and an Enterococcus faecium strain as vancomycin-resistant. Thirty-one (97%) of 32 laboratories correctly reported the Streptococcus pneumoniae strain as erythromycin-resistant. All laboratories testing the Pseudomonas aeruginosa strain against ciprofloxacin or ofloxacin correctly reported the organism as resistant. Of 40 laboratories, 30 (75%) correctly reported resistant MICs or zone sizes for the imipenem- and meropenem-resistant Serratia marcescens. For the extended-spectrum beta-lactamase (ESBL)-producing strain of Klebsiella pneumoniae, 18 (42%) of 43 laboratories testing ceftazidime correctly reported ceftazidime MICs in the resistant range. These results suggest that current testing generally produces accurate results, although some laboratories have difficulty detecting resistance to carbapenems and extended-spectrum cephalosporins. This highlights the need for monitoring how well susceptibility test systems in clinical laboratories detect emerging resistance. (C) 2000 Elsevier Science Inc. All rights reserved.

关键词：氨基糖苷类抗菌药/药理学抗感染药/药理学环丙沙星/药理学交叉感染/药物疗法交叉感染/微生物学交叉感染/预防和控制抗药性微生物肠球菌屎/药物作用红霉素/药理学亚胺培南/药理学实验室医院/标准实验室医院/统计学和数值数据氧氟沙星/药理学苯唑西林/药理学青霉素类/药理学假单胞菌铜绿/药物作用可重复性结果沙雷菌黏质/药物作用葡萄球菌金黄色/药物作用链球菌肺炎/药物作用噻烯霉素类/药理学万古霉素/药理学人类

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Emerging therapies for serious gram-positive bacterial infections: A focus on linezolid

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CLINICAL INFECTIOUS DISEASES 2000年第Sup4期31卷 S144-S149页

作者： Plouffe, JF Ohio State Univ Coll Med Div Infect Dis Columbus OH 43210 USA

Respiratory tract infections and skin and soft-tissue infections frequently are caused by gram-positive cocci, and treating these infections with standard antibiotics has recently become problematic. Many of the primary pathogens causing these infections are now resistant to current standard treatment regimens. In addition, the frequency of these infections is increasing, particularly among patients with complex medical conditions. Thus, new and effective antimicrobial agents are needed, and many are currently in various stages of development. Linezolid, the first approved oxazolidinone, has enhanced activity against gram-positive organisms. Recent results of 5 large, randomized, phase 3 trials evaluating linezolid for the treatment of community-acquired pneumonia, nosocomial pneumonia, and uncomplicated and complicated skin and soft-tissue infections are encouraging and indicate that linezolid is as effective as standard comparator agents as therapy for these infections. Thus, the recent availability of linezolid offers clinicians a promising new agent for the treatment of serious gram-positive bacterial infections.

关键词：乙酰胺类/治疗应用抗感染药/治疗应用社区获得性感染/药物疗法交叉感染/药物疗法革兰氏阳性菌感染/药物疗法恶唑烷酮类/治疗应用肺炎细菌性/药物疗法皮肤疾病细菌性/药物疗法人类

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Intermittent and continuous ceftazidime infusion for critically ill trauma patients

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AMERICAN JOURNAL OF SURGERY 2000年第6期179卷 436-440页

作者： Hanes, SD Wood, GC Herring, V Croce, MA Fabian, TC Pritchard, E Boucher, BA Univ Tennessee Ctr Hlth Sci Dept Clin Pharm Memphis TN 38163 USA Univ Tennessee Ctr Hlth Sci Dept Surg Memphis TN 38163 USA

BACKGROUND: The adequacy of intermittent and continuous infusion ceftazidime for the treatment of nosocomial pneumonia in critically ill trauma patients was assessed by analyzing ceftazidime pharmacokinetics in relation to the minimum inhibitory concentration (MIC) and treatment outcome. METHODS: Serial blood samples were obtained during ceftazidime therapy in 31 trauma patients. Ceftaridime pharmacokinetics were compared with that of previously studied healthy volunteers. Ceftazidime pharmacokinetics were analyzed according to the time above the MIC and treatment outcome. RESULTS: Critically ill trauma patients had a significantly increased volume of distribution and clearance (0.32 +/- 0.14 L/kg and 2.35 a 0.89 mL . min(-1) . kg(-1), respectively) compared with healthy volunteers (0.21 +/- 0.03 and 1.58 +/- 0.23 mL . min(-1) . kg(-1)). The time above the MIC was greater than or equal to 92% of the dosing interval for all patients and treatment outcomes were similar between the two treatment groups. CONCLUSIONS: Ceftazidime pharmacokinetics are significantly altered in critically ill trauma patients. Both intermittent and continuous ceftazidime regimens were equally effective for the treatment of nosocomial pneumonia caused by less virulent bacteria. (C) 2000 by Excerpta Medica, Inc.

关键词：头孢他啶/投药和剂量头孢他啶/药代动力学头孢菌素类/投药和剂量头孢菌素类/药代动力学卡方分布危重病交叉感染/诊断交叉感染/药物疗法用药计划表随访研究革兰氏阴性菌/药物作用革兰氏阴性菌感染/诊断革兰氏阴性菌感染/药物疗法输注静脉内微生物敏感性试验肺炎细菌性/诊断肺炎细菌性/药物疗法概率治疗结果创伤和损伤/微生物学青少年成年人老年人女(雌)性人类男(雄)性中年人

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Pseudo-outbreak of methicillin-resistant Staphylococcus aureus

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MAYO CLINIC PROCEEDINGS 1999年第9期74卷 885-889页

作者： Ender, PT Durning, SJ Woelk, WK Brockett, RM Astorga, A Reddy, R Meier, PA Wright Patterson Med Ctr Div Infect Dis Wright Patterson AFB OH USA Wright Patterson Med Ctr Dept Internal Med Wright Patterson AFB OH USA Wright Patterson Med Ctr Dept Pathol Wright Patterson AFB OH USA Wilford Hall USAF Med Ctr Div Infect Dis Lackland AFB TX 78236 USA Wilford Hall USAF Med Ctr Dept Pathol Lackland AFB TX 78236 USA

Objective: To determine whether a high rate of methicillin-resistant Staphylococcus aureus at our institution was due to laboratory misclassification and to evaluate the effect of this misclassification. Material and Methods: We evaluated all S aureus isolates identified at our institution during a 60-day period in 1997, Automated susceptibility test results (using the Vitek system) from our clinical microbiology laboratory and an independent laboratory were compared with oxacillin agar screen plate results at both laboratories. Isolates with discordant results for susceptibility to oxacillin were tested by broth microdilution minimal inhibitory concentrations and for the presence of the mecA gene. Results: Eighteen (72%) of the 25 organisms (obtained from 17 patients) found to be resistant to oxacillin by the Vitek system at our institution were susceptible by the oxacillin agar screen. Discordant isolates tested by broth microdilution minimal inhibitory concentrations and for the mecA gene were found to be oxacillin susceptible and mecA gene negative. Thus, at our hospital, almost three fourths of the organisms initially identified as methicillin-resistant S aureus by the Vitek system were actually susceptible to oxacillin, This misclassification resulted in needless infection control measures and unnecessary vancomycin use. Conclusion: Hospitals that use only automated susceptibility testing for S aureus should periodically validate their results with additional testing.

关键词：交叉感染/药物疗法交叉感染/病因学交叉感染/微生物学疾病暴发流行甲氧西林抗药性微生物敏感性试验俄亥俄/流行病学苯唑西林/治疗应用青霉素类/治疗应用试剂盒诊断葡萄球菌感染/药物疗法葡萄球菌感染/流行病学金黄色葡萄球菌/药物作用人类

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Clinical and economic evaluation of subsequent infection following intravenous ciprofloxacin or imipenem therapy in hospitalized patients with severe pneumonia

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 1999年第Sup1期43卷 129-134页

作者： Caldwell, JW Singh, S Johnson, RH Univ Calif Los Angeles Dept Med Kern Med Ctr Bakersfield CA 93305 USA

A recent multicentre clinical study evaluated the safety and efficacy of iv ciprofloxacin therapy compared with imipenem-cilastatin in hospitalized patients with severe pneumonia. Monotherapy with iv ciprofloxacin was at least equivalent to imipenem in terms of bacteriological eradication and clinical response. In a single-centre, retrospective, post-therapy evaluation of persistent and subsequent infection, the incidence of Gram-negative infections and associated costs were compared. The main elements of the economic analysis included costs of additional antimicrobial therapy and hospitalization. Thirty-two patients were randomized into the study, of whom 27 were efficacy-valid. The 13 patients randomized into the ciprofloxacin group were not significantly different from the 14 patients in the imipenem group in terms of clinical parameters. Clinical cure occurred in ten of 13 patients (77%) in the ciprofloxacin group and in seven of 14(50%) in the imipenem group. Bacteriological eradication was achieved in 11 of 13 (85%) ciprofloxacin-treated and eight of 14 (57%) imipenem-treated patients. Five of 13 (38%) patients in the ciprofloxacin group and nine of 14(64%) in the imipenem group experienced persistent or subsequent infection requiring post-treatment antimicrobials. In these five ciprofloxacin patients, three had cultures with Gram-positive organisms only and two had cultures with both Gram-positive and Gram-negative organisms. In the nine imipenem-treated patients requiring post-study antimicrobials, all had Gram-negative bacteria and three also had Gram-positive organisms. The incidence of subsequent Gram-negative infection in the two groups (15% vs 64%) was significantly different (P < 0.05). Pseudomonas aeruginosa was isolated from seven patients in the imipenem group but only one in the ciprofloxacin group (P < 0.05). Subsequent costs for post-therapy antimicrobials and hospital stay while receiving study and post-study drug therapy were evaluated;the cost

关键词：抗感染药/经济学抗感染药/治疗应用环丙沙星/经济学环丙沙星/治疗应用费用效益分析交叉感染/药物疗法交叉感染/经济学交叉感染/微生物学双盲法革兰氏阴性菌感染/药物疗法革兰氏阴性菌感染/经济学革兰氏阳性菌感染/药物疗法革兰氏阳性菌感染/经济学卫生保健费用亚胺培南/经济学亚胺培南/治疗应用病人入院肺炎细菌性/药物疗法肺炎细菌性/经济学前瞻性研究回顾性研究噻烯霉素类/经济学噻烯霉素类/治疗应用成年人女(雌)性人类男(雄)性

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