投稿分類 抗生素管制

主委發表種類: 壁報

投稿標題(中): 感染抗藥性綠膿桿菌之危險因素評估及選擇適合之經驗性抗生素合併療法

投稿標題(英): Risk factors for infected by resistant Pseudomonas aeruginosa and the choice of appropriate empirical combination regimen.

投稿摘要: 1. Background: Pseudomonas aeruginosa (PA) is the pathogen caused nosocomial infections which always recognized high mortality. One of the key points to reduce mortality is to identify the population which might carried resistant PA and choose the appropriated empirical antimicrobial. The purpose of this study is to identified the population who might infected with resistant PA and developing the suitable empirical combination regimens to help physician choice.

2. Materials and Methods:
2.1 The difference of isolates susceptibility between multiple risk factors (Age＞ 65, critical care units (ICU) isolated, Gender, Culture types) with single agents and combination regimens were using uni-variate logistic analysis.

2.2 The susceptibility is calculated with single anti-pseudomonal agents (ceftazidime, cefepime, imipenem, meropenem, piperacillin-tazobactam, ciprofloxacin, levofloxacin, gentamicin and amikacin) or in combination with an aminoglycosides (gentamicin or amikacin) or fluoroquinolones(ciprofloxacin or levofloxacin) were calculated. The combination regimens susceptibility was defined as isolates susceptible to at least one of the dual agents.

3. Discussion: The result showed that ICU isolated is less susceptibility with single agents and combination regimens. ICU administration may be one of the risk factors to cause carriage of resistant PA. The amikacin-containing regimes has most highly coverage rate to all isolates. The levofloxacin provide the less additive coverage rate to all combination regimens. All combination regimens are expanded empirical coverage rate than the single agents.

4. Conclusion: Empirical combination regimens to all patient population still controversial. However, previous study had showed there still be the benefit to critical illness patients before culture susceptibility result was known. Our study figures out the population with the risk of carriage resistant PA and provides the combination regimens susceptibility to help clinical healthcare provider making decision.

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