投稿分類 抗生素管制

主委發表種類: 壁報

投稿標題(中): 抗生素管理計劃介入前後抗生素耗用量和綠膿桿菌抗藥性的關聯性

投稿標題(英): Correlation between antibiotic consumption and resistance of pseudomonas aeruginosa: A observational study evaluated the impact of antimicrobial stewardship programs implanted

投稿摘要: 1. Background: Pseudomonas aeruginosa (PA) is the common hospital-acquired Gram-negative pathogen cause pneumonia, urinary react infection (UTI) and bacteremia. Previous study had found the positive correlation between PA resistance and antibiotics consumption. Developing the suitable antimicrobial stewardship programs (ASPs) to restricted antibiotic consumption play an important role in controlling resistance. The purpose of this study is to figure out the relationship between antibiotics consumption and PA resistance and evaluate the impact after ASPs implemented in the study hospital from 2004 to 2017.

2. Materials and methods:
2-1 The anti-pseudomonal antibiotics included in the study: ceftazidime, cefepime, meropenem, imipenem, piperacillin-tazobactam, ciprofloxacin, levofloxacin, gentamicin and amikacin.
2-2 The amount of antibiotics consumption presented as defined daily doses (DID) per 1,000 patient-days (DDD/1,000PD). The resistant rate and antibiotics consumption were investigated every 6 months. The relationship between resistance and antimicrobial consumption were using linear regression to analysis.
2-3 The ASPs in the study hospital including: (a) strictly control carbapenem and levofloxacin consumption. (b) Extended-infusion of piperacillin-tazobactam.

3. Discussion: The gentamcin, amikacin, levofloxacin, piperacillin-tazobactam consumption showed positive correlated with PA resistance. After strictly restricted carbapenem (imipenem and meropenem) consumption under 15 DID since 2004, resistance keeps stable in the following 10 years. The levofloxacin consumption increased year by year. To reduced PA resistance to levofloxacin, we strictly restricted levofloxacin usage since 2007 then the resistance dramatically decreased. As the first choice of beta-lactam agent to treat PA infection, piperacillin-tazobactam consumption and resistance also increased. Instead of controlled the piperacillin-tazobactam consumption, we implanted extended-infusion policy to reduce the piperacillin-tazobactam resistance since 2009. After implanted the policy, resistance of piperacillin-tazobactam keeps stable in the following years.

4. Conclusion: The proper of antibiotics use is important to avoid the emergence of resistance. Developing the suitable ASPs intervention played a key role to reduce resistance in the study hospital.

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