碳青霉烯抗生素处方限制策略对呼吸机相关性肺炎多药耐药鲍曼不动杆菌发生率的影响

Carbapenem restriction reduce the incidence of multidrug-resistant Acinetobacter baumannii in ventilator associated pneumonia

目的分析重症监护病房（ICU）内碳青霉烯抗生素的处方量与呼吸机相关性肺炎（VAP）多药耐药（MDR）鲍曼不动杆菌发生率的关系。方法选择2007年6-12月四川大学华西医院ICU收治的行机械通气的VAP患者26例，随机分为采用碳青霉烯抗生素“处方限制策略”组（限制组，12例）和不加限制组（常规组，14例），收集两组患者治疗期的痰标本，分析MDR细菌的分布及与同期碳青霉烯抗生素处方量的相关性。结果限制组碳青霉烯抗生素处方量以及MDR鲍曼不动杆菌的发生率均较常规组显著降低，差异有统计学意义[处方量：61g比188g，发生率：10．7％（7／65）比17．8％（13／73），P均〈0．053。提示MDR鲍曼不动杆菌发生率的降低归因于碳青霉烯处方量的减少。结论采取碳青霉烯“处方限制策略”可以减少VAPMDR鲍曼不动杆菌的发生率。

Objective To determine the relation of carbapenem restriction with the incidence of multidrug-resistant （MDR） Acinetobacter baumannii in ventilator associated pneumonia （VAP）. Methods Twenty-six patients admitted to the intensive care unit, West China Hospital, Sichuan University, from June to December in 2007, with confirmed VAP were randomized to two groups： conventional group （14 cases） and carbapenem restriction group （12 cases）. All sputum samples were collected throughout the trial. The correlation between the incidence of MDR Acinetobacter baumannii and the consumption of carbapenem was analyzed. Results The incidence of MDR Acinetobacter baumannii （10.7%, 7/65） and consumption of carbapenem （61g） in carbapenem restriction group were significantly lower than conventional group （17.8%, 13/73, 188 g, both P〈0.05）. The result implied that the decreased incidence of MDR Acinetobacter baumannii was attributable to the reduction of carbapenem consumption. Conclusion Carbapenem constraint could reduce the incidence of MDR Acinetobacter baumannii in VAP.