icu

减少ICU中抗生素抵抗病原体发生率的策略

Strategies to Reduce the Incidence of Antibiotic-Resistant Pathogens in the ICU
Henry Masur, MD
Introduction
At the 32nd Critical Care Congress, strategies to reduce the frequency of antibiotic-resistant pathogens received considerable attention. Marin H. Kollef, MD,[1] of Washington University School of Medicine in Manchester, Missouri, stressed that in every intensive care unit (ICU), the incidence of resistance should be closely monitored, just as ICUs monitor the frequency of self-extubations and deep vein thrombosis. Collecting and reviewing data that indicate what the pathogens are in a unit, and what their antimicrobial susceptibility is, must be the foundation for an ICU's program to reduce the incidence of infectious complications, and to minimize antibiotic resistance.
　

　Antibiotic Rotation in the ICU
　　Antibiotic Use in Sepsis
　　Focusing Drug Antibiotic Delivery on Infected Tissue
　　Limiting Antibiotic Use in the ICU
　　Once-Daily Dosing of Aminoglycosides
　　New Agents on the Horizon
References
1. Kollef MH. Infection: antibiotics. Rotation of empiric antibiotics in the ICU. Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.
2. Rahal JJ, Urban C, Horn D, et al. Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA. 1998;280:1233-1237.
3. Kollef MH. Hospital-acquired pneumonia and de-escalation of antimicrobial treatment. Crit Care Med. 2001;29:1473-1475.
4. Kollef MH. Is there a role for antibiotic cycling in the intensive care unit? Crit Care Med. 2001;29(4 suppl):N135-N142.
5. Landman D, Chockalingam M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary. Clin Infect Dis. 1999;28:1062-1066.
6. Gruson D, Hilbert G, Vargas F, et al. Rotation and restricted use of antibiotics in a medical intensive care unit. Impact on the incidence of ventilator-associated pneumonia caused by antibiotic-resistant gram-negative bacteria. Am J Respir Crit Care Med. 2000;162(3 Pt 1):837-843.
7. Cohen J. Infection: antibiotics. Antibiotic choice in sepsis: Does it really matter? Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.
8. Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980;68:344-355.
9. Warren HS. Infection: antibiotics. Can aminoglycosides be targeted to infected tissue by using chemoattractant peptides? Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.
10. Marshall J. Infection: antibiotics. Minimizing antibiotic use in the ICU. Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.
11. Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000;162(2 Pt 1):505-511.
12. Fagon JY, Chastre J, Wolff M, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med. 2000;132:621-630.
13. Timm E. Infection: antibiotics. Once daily aminoglycoside dosing in ICU patients. Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.
14. O'Grady N. Infection: antibiotics. New agents in late-stage development. Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.