ICU最新研究进展.doc

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 ICUHenry Masur, MD IntroductionAt 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 ICUs program to reduce the incidence of infectious complications, and to minimize antibiotic resistance.　　Antibiotic Rotation in the ICU Antibiotic Rotation in the ICU　　Restricting antibiotics is one approach to minimizing the incidence of antibiotic resistance, but decreasing the duration of antibiotic courses deserves emphasis as well. Cycling and rotation of antibiotics represent attempts to minimize resistance against one particular drug. This strategy can restore susceptibility of organisms to that one particular drug. Rahal and colleagues[2] published a before-and-after study in 1998 looking at the incidence of cephalosporin-resistant extended-spectrum beta-lactamase-producing Klebsiella during a period of time when cephalosporins were widely used. They showed that restricting the use of cephalosporins in favor of carbapenems reduced the incidence of cephalosporin-resistant Klebsiella dramatically. However, the incidence of imipenem-resistant Pseudomonas increased substantially. Rahals approach really exchanged one type of resistance for another type of resistance. This strategy exchanges one homogeneous strategy of antibiotic use for another homogeneous strategy, rather than using a heterogeneous strategy that might not lead to so much resistance against one clas