厄他培南应用对医院革兰阴性菌耐药性影响的系统综述

Impact of ertapenem on the resistance of Gram-negative bacteria: A systematic review

目的:探讨厄他培南应用对于医院革兰阴性菌耐药性的影响,为医院抗菌药物管理提供决策支持。方法:对相关中、英文数据库中关于厄他培南对医院革兰阴性菌耐药性影响的文献进行系统综述。结果:经计算机系统检索到4098篇文献,进一步筛选得到17篇符合入选和排除标准的文献。所纳入文献研究的菌种主要为院内感染常见的铜绿假单胞菌(Pseudomonas aeruginosa,Pae),鲍曼不动杆菌(Acinetobacter baumannii,Aba)、大肠埃希菌(Escherichia coli,Eco)及肺炎克雷伯菌(Klebsiella pneumoniae,Kpn),研究周期从24个月至132个月不等,研究方法主要为时间序列分析法。由于研究环境,研究周期以及研究方法不完全相同,各文献的研究结果也不完全一致。对于Pae和Aba耐药性的影响主要有3种结果,即正向,负向和无影响;对于厄他培南抗菌谱可以覆盖的肠杆菌科细菌如Eco,Kpn的研究结果有两种即负向的影响和无影响。结论:厄他培南对于医院常见革兰阴性菌的耐药性并无明显的不利影响,有其适应证时可优先选用,但是各家医院有条件仍需进行持续性的耐药监测,以指导临床实践和抗菌药物管理。

OBJECTIVE To investigate the effect of ertapenem on the drug resistance of Gram-negative bacteria in hospitals,and to provide decision support for antimicrobial stewardship.METHODS A systematic review of the literature on the effect of ertapenem on drug resistance of Gram-negative bacteria in hospitals was conducted in relevant Chinese and English databases.RESULTS A total of 4098 studies were retrieved by computer system,17 articles of which met the inclusion and exclusion criteria by further screening.The strains included in the literature were mainly Pseudomonas aeruginosa(Pae),Acinetobacter baumannii(Aba),Escherichia coli(Eco)and Klebsiella Pneumoniae(Kpn),and the study period varied from 24 months to 132 months,and the main study method was time series analysis.As the environment,cycle and methods were not identical,the results were not completely consistent.Three main effects on the drug resistance of Pae and Aba were identified:positive,negative and no effect.With regard to Enterobacteriaceae such as Eco and Kpn which could be covered by ertapenem,there were two kinds of effects:negative and no impact.CONCLUSION Ertapenem have no obvious adverse effects on the resistance of common Gram-negative bacteria in hospitals.It could be used as a preferred medication for patients who have indications,but continuous surveillance is needed to guide clinical practice and stewardship programmes.