天津某医院医院感染监测与抗菌药物使用策略的研究
|
摘要
第一部分某医院消化内科2007.1-2008.12医院感染监测的研究
目的对某医院消化内科的医院感染数据进行描述性研究,以揭示医院感染的分布规律和变化趋势。
方法以前瞻性调查方法对2007.1-2008.12该院消化内科的住院病人进行医院感染调查。
结果
1.共调查住院病人4,198例,医院感染人数394例,医院感染发病率为9.39%,发病密度为3.030例/1000住院日；医院感染发病例次数457例次,例次发病率为10.89%,例次发病密度为3.515例/1000住院日。2.常见医院感染发病部位按构成比依次为：原发性腹膜炎(23%)、血流感染(20%)、上呼吸道感染(20%)和下呼吸道感染(17%),以上占全部医院感染比例4/5。
3.医院内上呼吸道感染在第一季度构成排列最高。医院内血流感染呈稳定高水平表现,医院内原发性腹膜炎有稳定下降趋势。
4.各类医院感染中,按照以治愈/好转率由高到低依次为胃肠道、上呼吸道、原发性腹膜炎、皮肤软组织、血流感染和下呼吸道感染。自动出院和死亡率最高的两个部位是下呼吸道(18.18%)、血流(17.39%)。各部位医院感染的病死率以腹腔内组织感染为最高(11%),其次是下呼吸道感染(8.70%)和血流感染(7.32%)。
5.各病区中,A2病房医院感染发生强度最高,为4.417例次/1000住院日。其中,血流感染发生强度最高的为A2病房(1.646例次/1000住院日),上呼吸道感染发生强度最高的为A5病房(1.459例次/1000住院日),下呼吸道感染发生强度最高的为A2病房(1.084例次/1000住院日)。
6.院内腹膜炎感染治疗中每例用于抗菌药物支出的中位数为1,034.40元,四分位区间为693.60-2,579.60。医院内血流感染每例用于抗菌药物支出的中位数为1,030.60元,四分位区间为592.10-2,202.20。院内上呼吸道感染每例用于抗菌药物支出的中位数为442.40元,四分位区间为353.40-632.00。院内下呼吸道感染每例用于抗菌药物支出的中位数为1,635.20元,四分位区间为879.10-2,975.75。院内泌尿系感染每例用于抗菌药物支出的中位数为632.00元,四分位区间为458.92-1,352.60。
小结
1.本研究采用前瞻性医院感染监测方法,得出较为准确的科学数据,为医院感染发病指标的标准化奠定基础。
2.该院消化内科医院感染率有季节变化特点。其医院内上呼吸道感染在第一季度发病密度最高。
3.A2病区(重肝科)是医院感染监控的重点科室,血流感染和下呼吸道感染是其最常见的医院感染类型。
第二部分抗菌药物预防剖宫产手术部位感染国内文献荟萃分析
目的为剖宫产围手术期预防性使用抗生素方案制定提供循证依据。
方法检索中国生物医学文献数据库、维普、万方和MEDLINE等数据库,对抗菌药物预防剖宫产手术部位感染的临床随机对照研究进行收集、筛选、评价并提取数据进行荟萃分析。
结果
1.从国内文献数据库检索1989年-2008年20年间相关文献101篇。有30篇符合要求进入荟萃分析,占29.70%。
2.进入荟萃分析的30项研究共对7,346例剖宫产围手术期预防性使用抗生素的效果进行了观察,其中46.67%系2005年以后发表的。
3.荟萃分析表明首剂术前半小时到2小时或钳夹脐带后给予短期抗生素较术后长期使用抗生素预防剖宫产手术部位感染(OR=0.34,95%CI0.24-0.48)和产后病率(OR=0.40,95%CI0.32-0.48)的效果显著；对上述两种策略效果差异无论是在预防单纯选择性(OR=0.45,95%CI0.11-1.83)或是在选择/非选择性剖宫产术后子宫内膜炎上均没有统计学意义(OR=0.55,95％CI 0.16-1.96)。
4.文献质量偏低。其中4篇Jadad评分为2分,有15篇Jadad评分为1分,其他11篇的Jadad评分为0分。剔除敏感性最低的文献进行敏感性分析后,对术后子宫内膜炎预防荟萃分析显示,上述结果与原荟萃分析结果相近,未出现结果逆转。
小结术前半小时到2小时或钳夹脐带短期使用抗生素可作为预防剖宫产手术相关感染的一项策略。第三部分预防剖宫产手术部位感染抗生素使用策略的干预研究
目的：评价规范剖宫产围手术期预防性使用抗菌药物的临床效果。
方法：采用包括制定循证性很强的医院内剖宫产围手术期抗菌药物预防性使用指南、指南推荐术中钳夹脐带给与单剂一代头孢,同时增加剖宫产手术后手术部位感染监测等干预措施。对某三级医院产科干预后(2008年1月-2009年3月)前瞻性调查手术部位感染、术后子宫内膜炎、产后病率等,与干预前(2006年1月-2007年10月)随机回顾调查进行比较。
结果：
1.依从干预指南预防性使用抗菌药物的92例,等量随机抽取干预前病例比较,在年龄、孕程胎膜早破、妊高病、过期妊娠、术前住院时间、术前血白细胞计数等方面可比性相当。
2.干预前后剖宫产围手术期抗菌药物预防性使用策略的差异明显。表现为抗菌药物品种上干预前采用三代头孢菌素联合甲硝唑,干预后采用一代头孢菌素；预防用药首剂时间上干预前在术前1/2小时-2小时,干预后采用术中钳夹脐带；抗菌药物预防使用疗程上干预前为48小时,干预后仅单剂用药。
3.干预前后手术部位感染(浅表)发生情况分别为2.17%(2/92),1.89%(2/106),术后病率发生情况分别为3.26%(3/92),1.89%(2/106),均未见子宫内膜炎。
4.干预前后产妇出现外周血白细胞超过13G/L的情形分别为3.26%(3/92)和0.94%(1/106),p<0.25。术后外周血中性粒细胞比例超过80%的情形分别为28.26%(26/92)和28.30%(30/106)。术后体温分别为37.40±0.43摄氏度和37.33±0.49摄氏度,p=0.28。
5.干预前后娩出新生儿体重分别为3446±422克和3393±408克,p=0.36。娩出新生儿Apgar评分分别为9.62±0.88和9.79±0.50,p=0.10。Apgar<7的例数分别为2和O。
6.两种策略用于抗菌药的支出分别为221.15±67.53元和36.70±25.85元(p=0.00)。
小结：本研究对某医院产科2008年1月采用一代头孢菌素单剂钳夹脐带给药作为剖宫产围手术期预防性使用抗菌药物干预,与之前的策略相比在用药品种、预防疗程、首剂时间等方面有所不同。显示干预后的手术相关感染控制效果相当,住院费用(抗菌药物)显著下降。
第四部分某医院抗菌药物使用管理的效果评价
目的：评价抗菌药物管理策略对医院内抗菌药物使用影响。
方法：2006-2008年间在某医院推行包括建立抗菌药物合理使用指导小组、推进感染控制计划、制定针对性的抗生素使用指南、展开教育培训、提高对抗生素使用的监测、对临床使用的支持指导与反馈等一揽子干预策略。收集2005-2008年某医院全部抗菌药物使用频度、费用,2006-2008年该医院金黄色葡萄球菌和大肠杆菌对常用抗菌药物的敏感率。
结果：
1.抗菌药物占药品比例由3.32%降到2.79%。
2.收治患者100人均使用抗菌药物费用从224.20元降至152.04元,效果显著。
3.门诊每1000人次使用抗菌药物费用由406.00元降至274.70元。
4.咪唑类、抗真菌类、氟喹诺酮类、三代头孢菌素和含酶抑制剂的β-内酰胺类的收治患者人均使用频度降幅排在前列。
5.非限制类抗菌药物使用构成比例增加,其中p-内酰胺霉敏感青霉素类、大环内酯类、二代头孢菌素、四环素类、氨基糖苷类、磺胺类排在前列。
6.2006-2008年该医院金黄色葡萄球菌对苯唑西林敏感率逐渐上升,分别为71%到82%,p<0.05;对左氧氟沙星的敏感率总体上升,63%到88%,p<0.05。
7.2006-2008年该医院大肠杆菌对哌拉西林/舒巴坦的敏感性逐渐上升,38%增至62%,p<0.05；对环丙沙星/左氧氟沙星的敏感性总体上升,18%增至48%,p<0.05。
小结：
1.系统而有活力的抗生素管理机制是抗生素合理使用的重要保障。
2.在干预中,该医院抗菌药物使用整体人均用量呈下降趋势,院抗菌药物使用构成中非限制使用抗菌药物比例呈逐渐上升趋势。
3.该院干预后期分离出的金黄色葡萄球菌对苯唑西林、左氧氟沙星的敏感率较干预初期显著上升；该院干预后期检出的大肠杆菌对哌拉西林/舒巴坦、环丙沙星/左氧氟沙星的敏感率较干预初期显著上升。
Part I Descriptive Study on Nosocomial Infection in Gestrointesitine Units in an Infectious Disease Hospital from 2007.1 to 2008.12
Objective To analyze the data of nosocomial infection (NI) in an infectious teaching hospital for 2 years (from 2007.1 to 2008.12) and reveal the distribution and tendency.
Methods To investigate prospectively the incidence of nosocomial infection among in-Patients during 2007.1 and 2008.12.
Results
1. All 4,198 cases were involved during the surveillance,394 of which were aquired NI. And the incidence of NI was 9.39%, the incidence density of NI was 3.030/1000patient days.457 times attacked, the case-times incidence was 10.89%, the case-times incidence density was 3.515/1000patient days.
2. The frequent NI sites are peritonitis (23%), blood stream infection (20%), uper respiratory tract infection (20%) and lower respiratory tract infection (17%), which holds 80% of all.
3. The nosocomial uper respiratory tract infections most frequently appeare in the first quarter of year. Nosocomial blood stream infections are stable higher. The incidence of nosocomial peritonitis trends down slowly.
4. The best cure of nosocomial infections is gastrointesital tract infection. Then uper resperitory tract infection, peritonitis, skin-soft tissu infection are followed. The lower respiratory tract infection and blood stream infection are on the top in motality and renunciative leaf-off rate.
5. The NI incidence in A2 unit is the highest by 4.417/1000patient days, most of which are blood stream infection (1.646/1000patient days) and lower respiratory tract infection (1.459/1000patient days). The incidence of nosocomial uper respiratory tract infection is highest in unit A5, a tradetional Chinese medicine unit,1.084/1000patient days.
6. The motality of nosocomial infection is the highest in intraperitoneal tissue infection (11%), followed by lower respiratory tract infection (8.70%) and blood stream infection (7.32%).
7. The median value of chemotherapy on single lower respiratory infection aquired in hospital is highest among all NI, by 1,635.20 RMB (592.10-2,202.20). The median value of chemotherapy on single blood streamm infection aquired in hospital is 1,030.60 RMB, (592.10-2,202.20). The median value of chemotherapy on single peritonitis aquired in hospital is 1,034.40 RMB, (693.60-2,579.60). The median value of chemotherapy on single urinary tract infection aquired in hospital is 632.00 RMB, (458.92-1,352.60).The median value of chemotherapy on single uper respiratory infection aquired in hospital is 442.40 RMB, (353.40-632.00).
Conclusion
1. It is iniatial prospective surveillance on nosocomial infection in China with more credible and scientific incidence, with which could be compared in advanced countries.
2. The unit A2 with the highest nosocimial blood stream infection and lower respiratory tract infection is the one that fits to be surveyed as a target object.
3. The upper respiratory tract infections aquired in hospital are most frequently in the first quarter of year.
Part II The Prophylactic Use of Antibiotics Administration in preventing Surgical Site Infection of Cesarean section:A Meta Analysis of randomized controlled trials in China
Objective To evaluate the impact on surgical site infection (SSI), postpartum endometritis and/or puerperal morbidity by prophylactic administration of antibiotics in cesarean section.
Methods Comprehensive Chinese randomized controlled trials retrieval about preventing postpartum infection related to cesarean section by antibiotics prophylactic uses was performed via searching electronic database, hand searching bibliographies of books and relevant journals.
Results Compared with long term antibiotics prophylaxis started after operation, short term antibiotics prophylaxis started at time during 1/2 to 2 hours before operation or started after umbilical cord clamped showed lower surgical site infection (OR=0.34,95%CI0.24-0.48) and puerperal morbidity(OR=0.40,95%CI0.32-0.48) significantly, and lower postpartum endometritis incidence in selective C-section(OR=0.45,95%CI 0.11-1.83) or unselective C-section (OR=0.55,95%CI 0.16-1.96).
Conclusion This meta analysis indicated that short term antibiotics prophylaxis started at time during 1/2 to 2 hours before operation or started after umbilical cord clamped is a strategy for improving to prevent SSI and puerperal morbidity.
PartⅢThe evaluation of intervention of prophylactic use of first generation of cephalosporins in Cesarean section by single dose
Objective The purpose of this history comparison between retrospective and prospective study was to determine the evidence-based hospital-made guideline of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity.
Methods The intervention included to provide evidence-based guideline of prophylactic use of antimicrobial for cesarean section, increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction. Single-dose of first generation cephalosporins at cord clamping was guided as prophylactic use of antimicrobial for sesarean section. In the pre intervention periods, a retrospective collection of antimicrobial consumption and surgical site infections were measured randomly.
Results
1. Patients evaluated increased from 0 to 100% and the SSI rates in both periods were 2.17% to 1.89%, respectively. The difference of rates of术后病率between pre and post intervention (3.26% vs 1.89%) has not statistical significance. The endometritis before and after the intervention are not observed.
2. The count of white cell in peripheral blood more than 13G/L cases are 3 and 1 respectively. The rate of Neutrophil in peripheral blood WBC more than 80% cases are 26 and 30, respectively.
3. There was about 5/6 cost reduction in prophylactic antimicrobial use on average per cesarean section (RMB 221.15±67.53 to RMB 36.70±25.85).
4. neonatal weight are 3446±422 g and 3393±408, respectively between before and after intervention, p=0.36. The Apgar scores are 9.62±0.88 and 9.79±0.50, p=0.10. The rates of neonatal Apgar score less than 7 cases are 2.17% and 0.
Conclusion
1. An ample intervention, including administrative and educational measures, led to high compliance with the first generation of cephalosporins within less than 24 hours after the operation. and saved more except bacterial resistence pressure.
2. There was no difference in maternal infectious morbidity whether the duration of cefotazidine given before skin incision were at least 48 hours or single dose of the first generation of cephalosporins at cord clamping.
Part IV The trend in antibacterial agents consumption by the appropriate use of antibiotics program at a Infectious Disease Hospital
Objective To improve capability of antibiotics reasonable use in hospital.
Methods People-centred infection control programmes were implemented over a 3-year period (2006-2008) in an infectious disease hospital, which included acting out antibiotics reasonable use management, strengthening nosocomial control and improving their surveillance capabilities. It was taken to provide pertinent education on reasonable use of antibiotics and formulate antibiotics use guideline to relative infection.
Results
1. The percentage of antimicrobials in medicine cost in the hospital is decreased from 3.32% to 2.79%.
2. The cost of antimicrobials per 100 admitted patients is reduced continuously from RMB 224.20 to 152.04.
3. The cost of antimicrobials per 1000 admitted out-clinic patient-times shows decreased trend, RMB 406.00 to 274.70.
4. The Defined Daily Doses (DDDs) per 100 patients of antibacterial was on a degressive slope during the intervention. The DDDs per 100 patients of Imidazole derivatives, antimycotics, Fluoroquinolones, Third-generation cephalosporins and Beta-lactam antibacterials and enzyme inhibitors showed decrease marked in use.
5. At the same time the component consumption of some antibacterial, such as Macrolides, Beta-lactamase sensitive penicillins, Second-generation cephalosporins, Tetracyclines, Sulfonamides and trimethoprim, and other aminoglycosides excluded streptomycins, were increased markedly.
6. The sensibility rate of Staphylococcus aureus rises to oxacillin continuously from 71% to 82%; The one to levofloxacin rises from 63% in 2006 to 88% in 2008.
7. Among strains of E.coli, the susceptibility to piperacillin/tazobactam increases from 38% to 62%; This trend is also in the susceptibility to ciprofloxacin/levofloxacin, from 18% to 48%.
Conclusion Systematic and active strategy of appropriated use of antibiotics improving access and changing behaviour placed a key role but took time. The successful reduction of the third generation of cephalosporins and increases the susceptibility to E. coli and S. aureus. The longer effect of intervention existed.
目的对某医院消化内科的医院感染数据进行描述性研究,以揭示医院感染的分布规律和变化趋势。
方法以前瞻性调查方法对2007.1-2008.12该院消化内科的住院病人进行医院感染调查。
结果
1.共调查住院病人4,198例,医院感染人数394例,医院感染发病率为9.39%,发病密度为3.030例/1000住院日；医院感染发病例次数457例次,例次发病率为10.89%,例次发病密度为3.515例/1000住院日。2.常见医院感染发病部位按构成比依次为：原发性腹膜炎(23%)、血流感染(20%)、上呼吸道感染(20%)和下呼吸道感染(17%),以上占全部医院感染比例4/5。
3.医院内上呼吸道感染在第一季度构成排列最高。医院内血流感染呈稳定高水平表现,医院内原发性腹膜炎有稳定下降趋势。
4.各类医院感染中,按照以治愈/好转率由高到低依次为胃肠道、上呼吸道、原发性腹膜炎、皮肤软组织、血流感染和下呼吸道感染。自动出院和死亡率最高的两个部位是下呼吸道(18.18%)、血流(17.39%)。各部位医院感染的病死率以腹腔内组织感染为最高(11%),其次是下呼吸道感染(8.70%)和血流感染(7.32%)。
5.各病区中,A2病房医院感染发生强度最高,为4.417例次/1000住院日。其中,血流感染发生强度最高的为A2病房(1.646例次/1000住院日),上呼吸道感染发生强度最高的为A5病房(1.459例次/1000住院日),下呼吸道感染发生强度最高的为A2病房(1.084例次/1000住院日)。
6.院内腹膜炎感染治疗中每例用于抗菌药物支出的中位数为1,034.40元,四分位区间为693.60-2,579.60。医院内血流感染每例用于抗菌药物支出的中位数为1,030.60元,四分位区间为592.10-2,202.20。院内上呼吸道感染每例用于抗菌药物支出的中位数为442.40元,四分位区间为353.40-632.00。院内下呼吸道感染每例用于抗菌药物支出的中位数为1,635.20元,四分位区间为879.10-2,975.75。院内泌尿系感染每例用于抗菌药物支出的中位数为632.00元,四分位区间为458.92-1,352.60。
小结
1.本研究采用前瞻性医院感染监测方法,得出较为准确的科学数据,为医院感染发病指标的标准化奠定基础。
2.该院消化内科医院感染率有季节变化特点。其医院内上呼吸道感染在第一季度发病密度最高。
3.A2病区(重肝科)是医院感染监控的重点科室,血流感染和下呼吸道感染是其最常见的医院感染类型。
第二部分抗菌药物预防剖宫产手术部位感染国内文献荟萃分析
目的为剖宫产围手术期预防性使用抗生素方案制定提供循证依据。
方法检索中国生物医学文献数据库、维普、万方和MEDLINE等数据库,对抗菌药物预防剖宫产手术部位感染的临床随机对照研究进行收集、筛选、评价并提取数据进行荟萃分析。
结果
1.从国内文献数据库检索1989年-2008年20年间相关文献101篇。有30篇符合要求进入荟萃分析,占29.70%。
2.进入荟萃分析的30项研究共对7,346例剖宫产围手术期预防性使用抗生素的效果进行了观察,其中46.67%系2005年以后发表的。
3.荟萃分析表明首剂术前半小时到2小时或钳夹脐带后给予短期抗生素较术后长期使用抗生素预防剖宫产手术部位感染(OR=0.34,95%CI0.24-0.48)和产后病率(OR=0.40,95%CI0.32-0.48)的效果显著；对上述两种策略效果差异无论是在预防单纯选择性(OR=0.45,95%CI0.11-1.83)或是在选择/非选择性剖宫产术后子宫内膜炎上均没有统计学意义(OR=0.55,95％CI 0.16-1.96)。
4.文献质量偏低。其中4篇Jadad评分为2分,有15篇Jadad评分为1分,其他11篇的Jadad评分为0分。剔除敏感性最低的文献进行敏感性分析后,对术后子宫内膜炎预防荟萃分析显示,上述结果与原荟萃分析结果相近,未出现结果逆转。
小结术前半小时到2小时或钳夹脐带短期使用抗生素可作为预防剖宫产手术相关感染的一项策略。第三部分预防剖宫产手术部位感染抗生素使用策略的干预研究
目的：评价规范剖宫产围手术期预防性使用抗菌药物的临床效果。
方法：采用包括制定循证性很强的医院内剖宫产围手术期抗菌药物预防性使用指南、指南推荐术中钳夹脐带给与单剂一代头孢,同时增加剖宫产手术后手术部位感染监测等干预措施。对某三级医院产科干预后(2008年1月-2009年3月)前瞻性调查手术部位感染、术后子宫内膜炎、产后病率等,与干预前(2006年1月-2007年10月)随机回顾调查进行比较。
结果：
1.依从干预指南预防性使用抗菌药物的92例,等量随机抽取干预前病例比较,在年龄、孕程胎膜早破、妊高病、过期妊娠、术前住院时间、术前血白细胞计数等方面可比性相当。
2.干预前后剖宫产围手术期抗菌药物预防性使用策略的差异明显。表现为抗菌药物品种上干预前采用三代头孢菌素联合甲硝唑,干预后采用一代头孢菌素；预防用药首剂时间上干预前在术前1/2小时-2小时,干预后采用术中钳夹脐带；抗菌药物预防使用疗程上干预前为48小时,干预后仅单剂用药。
3.干预前后手术部位感染(浅表)发生情况分别为2.17%(2/92),1.89%(2/106),术后病率发生情况分别为3.26%(3/92),1.89%(2/106),均未见子宫内膜炎。
4.干预前后产妇出现外周血白细胞超过13G/L的情形分别为3.26%(3/92)和0.94%(1/106),p<0.25。术后外周血中性粒细胞比例超过80%的情形分别为28.26%(26/92)和28.30%(30/106)。术后体温分别为37.40±0.43摄氏度和37.33±0.49摄氏度,p=0.28。
5.干预前后娩出新生儿体重分别为3446±422克和3393±408克,p=0.36。娩出新生儿Apgar评分分别为9.62±0.88和9.79±0.50,p=0.10。Apgar<7的例数分别为2和O。
6.两种策略用于抗菌药的支出分别为221.15±67.53元和36.70±25.85元(p=0.00)。
小结：本研究对某医院产科2008年1月采用一代头孢菌素单剂钳夹脐带给药作为剖宫产围手术期预防性使用抗菌药物干预,与之前的策略相比在用药品种、预防疗程、首剂时间等方面有所不同。显示干预后的手术相关感染控制效果相当,住院费用(抗菌药物)显著下降。
第四部分某医院抗菌药物使用管理的效果评价
目的：评价抗菌药物管理策略对医院内抗菌药物使用影响。
方法：2006-2008年间在某医院推行包括建立抗菌药物合理使用指导小组、推进感染控制计划、制定针对性的抗生素使用指南、展开教育培训、提高对抗生素使用的监测、对临床使用的支持指导与反馈等一揽子干预策略。收集2005-2008年某医院全部抗菌药物使用频度、费用,2006-2008年该医院金黄色葡萄球菌和大肠杆菌对常用抗菌药物的敏感率。
结果：
1.抗菌药物占药品比例由3.32%降到2.79%。
2.收治患者100人均使用抗菌药物费用从224.20元降至152.04元,效果显著。
3.门诊每1000人次使用抗菌药物费用由406.00元降至274.70元。
4.咪唑类、抗真菌类、氟喹诺酮类、三代头孢菌素和含酶抑制剂的β-内酰胺类的收治患者人均使用频度降幅排在前列。
5.非限制类抗菌药物使用构成比例增加,其中p-内酰胺霉敏感青霉素类、大环内酯类、二代头孢菌素、四环素类、氨基糖苷类、磺胺类排在前列。
6.2006-2008年该医院金黄色葡萄球菌对苯唑西林敏感率逐渐上升,分别为71%到82%,p<0.05;对左氧氟沙星的敏感率总体上升,63%到88%,p<0.05。
7.2006-2008年该医院大肠杆菌对哌拉西林/舒巴坦的敏感性逐渐上升,38%增至62%,p<0.05；对环丙沙星/左氧氟沙星的敏感性总体上升,18%增至48%,p<0.05。
小结：
1.系统而有活力的抗生素管理机制是抗生素合理使用的重要保障。
2.在干预中,该医院抗菌药物使用整体人均用量呈下降趋势,院抗菌药物使用构成中非限制使用抗菌药物比例呈逐渐上升趋势。
3.该院干预后期分离出的金黄色葡萄球菌对苯唑西林、左氧氟沙星的敏感率较干预初期显著上升；该院干预后期检出的大肠杆菌对哌拉西林/舒巴坦、环丙沙星/左氧氟沙星的敏感率较干预初期显著上升。
Part I Descriptive Study on Nosocomial Infection in Gestrointesitine Units in an Infectious Disease Hospital from 2007.1 to 2008.12
Objective To analyze the data of nosocomial infection (NI) in an infectious teaching hospital for 2 years (from 2007.1 to 2008.12) and reveal the distribution and tendency.
Methods To investigate prospectively the incidence of nosocomial infection among in-Patients during 2007.1 and 2008.12.
Results
1. All 4,198 cases were involved during the surveillance,394 of which were aquired NI. And the incidence of NI was 9.39%, the incidence density of NI was 3.030/1000patient days.457 times attacked, the case-times incidence was 10.89%, the case-times incidence density was 3.515/1000patient days.
2. The frequent NI sites are peritonitis (23%), blood stream infection (20%), uper respiratory tract infection (20%) and lower respiratory tract infection (17%), which holds 80% of all.
3. The nosocomial uper respiratory tract infections most frequently appeare in the first quarter of year. Nosocomial blood stream infections are stable higher. The incidence of nosocomial peritonitis trends down slowly.
4. The best cure of nosocomial infections is gastrointesital tract infection. Then uper resperitory tract infection, peritonitis, skin-soft tissu infection are followed. The lower respiratory tract infection and blood stream infection are on the top in motality and renunciative leaf-off rate.
5. The NI incidence in A2 unit is the highest by 4.417/1000patient days, most of which are blood stream infection (1.646/1000patient days) and lower respiratory tract infection (1.459/1000patient days). The incidence of nosocomial uper respiratory tract infection is highest in unit A5, a tradetional Chinese medicine unit,1.084/1000patient days.
6. The motality of nosocomial infection is the highest in intraperitoneal tissue infection (11%), followed by lower respiratory tract infection (8.70%) and blood stream infection (7.32%).
7. The median value of chemotherapy on single lower respiratory infection aquired in hospital is highest among all NI, by 1,635.20 RMB (592.10-2,202.20). The median value of chemotherapy on single blood streamm infection aquired in hospital is 1,030.60 RMB, (592.10-2,202.20). The median value of chemotherapy on single peritonitis aquired in hospital is 1,034.40 RMB, (693.60-2,579.60). The median value of chemotherapy on single urinary tract infection aquired in hospital is 632.00 RMB, (458.92-1,352.60).The median value of chemotherapy on single uper respiratory infection aquired in hospital is 442.40 RMB, (353.40-632.00).
Conclusion
1. It is iniatial prospective surveillance on nosocomial infection in China with more credible and scientific incidence, with which could be compared in advanced countries.
2. The unit A2 with the highest nosocimial blood stream infection and lower respiratory tract infection is the one that fits to be surveyed as a target object.
3. The upper respiratory tract infections aquired in hospital are most frequently in the first quarter of year.
Part II The Prophylactic Use of Antibiotics Administration in preventing Surgical Site Infection of Cesarean section:A Meta Analysis of randomized controlled trials in China
Objective To evaluate the impact on surgical site infection (SSI), postpartum endometritis and/or puerperal morbidity by prophylactic administration of antibiotics in cesarean section.
Methods Comprehensive Chinese randomized controlled trials retrieval about preventing postpartum infection related to cesarean section by antibiotics prophylactic uses was performed via searching electronic database, hand searching bibliographies of books and relevant journals.
Results Compared with long term antibiotics prophylaxis started after operation, short term antibiotics prophylaxis started at time during 1/2 to 2 hours before operation or started after umbilical cord clamped showed lower surgical site infection (OR=0.34,95%CI0.24-0.48) and puerperal morbidity(OR=0.40,95%CI0.32-0.48) significantly, and lower postpartum endometritis incidence in selective C-section(OR=0.45,95%CI 0.11-1.83) or unselective C-section (OR=0.55,95%CI 0.16-1.96).
Conclusion This meta analysis indicated that short term antibiotics prophylaxis started at time during 1/2 to 2 hours before operation or started after umbilical cord clamped is a strategy for improving to prevent SSI and puerperal morbidity.
PartⅢThe evaluation of intervention of prophylactic use of first generation of cephalosporins in Cesarean section by single dose
Objective The purpose of this history comparison between retrospective and prospective study was to determine the evidence-based hospital-made guideline of prophylactic antibiotics at cesarean delivery influences maternal/neonatal infectious morbidity.
Methods The intervention included to provide evidence-based guideline of prophylactic use of antimicrobial for cesarean section, increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction. Single-dose of first generation cephalosporins at cord clamping was guided as prophylactic use of antimicrobial for sesarean section. In the pre intervention periods, a retrospective collection of antimicrobial consumption and surgical site infections were measured randomly.
Results
1. Patients evaluated increased from 0 to 100% and the SSI rates in both periods were 2.17% to 1.89%, respectively. The difference of rates of术后病率between pre and post intervention (3.26% vs 1.89%) has not statistical significance. The endometritis before and after the intervention are not observed.
2. The count of white cell in peripheral blood more than 13G/L cases are 3 and 1 respectively. The rate of Neutrophil in peripheral blood WBC more than 80% cases are 26 and 30, respectively.
3. There was about 5/6 cost reduction in prophylactic antimicrobial use on average per cesarean section (RMB 221.15±67.53 to RMB 36.70±25.85).
4. neonatal weight are 3446±422 g and 3393±408, respectively between before and after intervention, p=0.36. The Apgar scores are 9.62±0.88 and 9.79±0.50, p=0.10. The rates of neonatal Apgar score less than 7 cases are 2.17% and 0.
Conclusion
1. An ample intervention, including administrative and educational measures, led to high compliance with the first generation of cephalosporins within less than 24 hours after the operation. and saved more except bacterial resistence pressure.
2. There was no difference in maternal infectious morbidity whether the duration of cefotazidine given before skin incision were at least 48 hours or single dose of the first generation of cephalosporins at cord clamping.
Part IV The trend in antibacterial agents consumption by the appropriate use of antibiotics program at a Infectious Disease Hospital
Objective To improve capability of antibiotics reasonable use in hospital.
Methods People-centred infection control programmes were implemented over a 3-year period (2006-2008) in an infectious disease hospital, which included acting out antibiotics reasonable use management, strengthening nosocomial control and improving their surveillance capabilities. It was taken to provide pertinent education on reasonable use of antibiotics and formulate antibiotics use guideline to relative infection.
Results
1. The percentage of antimicrobials in medicine cost in the hospital is decreased from 3.32% to 2.79%.
2. The cost of antimicrobials per 100 admitted patients is reduced continuously from RMB 224.20 to 152.04.
3. The cost of antimicrobials per 1000 admitted out-clinic patient-times shows decreased trend, RMB 406.00 to 274.70.
4. The Defined Daily Doses (DDDs) per 100 patients of antibacterial was on a degressive slope during the intervention. The DDDs per 100 patients of Imidazole derivatives, antimycotics, Fluoroquinolones, Third-generation cephalosporins and Beta-lactam antibacterials and enzyme inhibitors showed decrease marked in use.
5. At the same time the component consumption of some antibacterial, such as Macrolides, Beta-lactamase sensitive penicillins, Second-generation cephalosporins, Tetracyclines, Sulfonamides and trimethoprim, and other aminoglycosides excluded streptomycins, were increased markedly.
6. The sensibility rate of Staphylococcus aureus rises to oxacillin continuously from 71% to 82%; The one to levofloxacin rises from 63% in 2006 to 88% in 2008.
7. Among strains of E.coli, the susceptibility to piperacillin/tazobactam increases from 38% to 62%; This trend is also in the susceptibility to ciprofloxacin/levofloxacin, from 18% to 48%.
Conclusion Systematic and active strategy of appropriated use of antibiotics improving access and changing behaviour placed a key role but took time. The successful reduction of the third generation of cephalosporins and increases the susceptibility to E. coli and S. aureus. The longer effect of intervention existed.
引文
[1]卫生部.医院感染诊断标准(试行)[S].北京：中华人民共和国卫生部,2001：
[2]Mayon-White RT et al. An international survey of the prevalence of hospital-acquired infection[J]. J Hosp Infect,1988,11 (Suppl A):43-48.
[3]Plowman R et al. The socio-economic burden of hospital-acquired infection. Euro Surveill,2000,5(4):49-50.
[4]陈进华,施长泰,汪能平.神经外科医院感染经济损失的病例对照研究[J].中华医院感染学杂志,1999,9(2)：87-88.
[5]Chen YY, Chou YC, Chou P. Impact of nosocomial nfection on cost of illness and length of stay in intensive care units[J]. Infect Control Hosp Epidemiol,2005,26(3):281-287.
[6]Wenzel RP. The economics of nosocomial infections[J]. J Hosp Infect, 1995,31(2):79-87.
[7]Kirkland KB et al. The impact of surgical-site infections in the 1990's: attributable mortality, excess length of hospitalization and extra costs[J]. Infect Control Hosp Epidemiol,1999,20(11):725-730.
[8]刘振声,金大鹏,陈增辉.医院感染管理学[M].北京：军事医学科学出版社,2000：
[9]Ponce-de-Leon S. The needs of developing countries and the resources required. J Hosp Infect,1991,18 (Suppl):376-381.
[10]Koln L, Colrigan J, Donaldson M. To err is human:buiding a safer health System[M]. Washington DC:Institute of Medicine National Academy Press,1999:
[11]Plowman R, Graves N, Crifill MAS, et al. The rate and cost of hospital-aquired infections occurring in patieins admitted to selected specialies of a disirtct general hospital in England and the national burden imposed[J]. Hosp Infect,2001; 47(3):198-209.
[12]胡必杰.当前医院感染研究领域中的热点问题明[J].上海护理,2003,3(2)：46-65.
[13]齐晓红,区少珍.ICU患者医院感染危险因素监测分析[J].中国感染控制杂志,2005,4(2)：50-52.
[14]任玲,周宏,茅一平等.神经外科手术患者医院感染目标性监测及感染相关危险因素分析[J].中国感染控制杂志,2006,16(2)：29-32.
[15]邢华燕,张卫东,范秋萍等.某医院1993年至200年下呼吸道医院感染分布及其危险因素监测[J].郑州大学学报(医学版),2004,39(4)：636-640.
[16]WHO. WHO Global Strategy for Containment of Antimicrobial Resistance[R]. Geneva:World Health Organization,2001:
[17]Struelens MJ. The epidemiology of antimicrobial resistance in hospital-acquired infections:problems and possible solutions[J]. BMJ, 1998,317:652-654.
[18]Centers for Disease Control and Prevention. A public health action plan to combat antimicrobial resistance. Atlanta:Centers for Disease Control and Prevention,2001:
[19]Department of Health. United Kingdom antimicrobial resistance strategy and action plan[S]. London:UK Department of Health,2000:
[20]World Health Organization. W.H.O. global strategy for containment of antimicrobial resistance[R]. Geneva:World Health Organization,2001:
[21]O'Brien TF. The global epidemic nature of antimicrobial resistance and the need to monitor and manage it locally[J]. Clin Infect Dis,1997,24 (Suppl 1):S2-8.
[22]O'Brien TF. Emergence, spread, and environmental effect of antimicrobial resistance:how use of an antimicrobial anywhere can increase resistance to any antimicrobial anywhere else[J]. Clin Infect Dis,2002,34 (Suppl 3): S78-84.
[23]Wenzel RP. National and international nosocomial infection surveillance system[A]. In:Wenzel RP, ed. Prevention and control of nosocomial infections[M]. Pennsylvania:Pillincott Williams & Wilkins,2003:109-119.
[24]陈清.医院感染的流行病学进展[J].新医学,2006,37(7)：430-433.
[25]吴安华,任南.全国医院感染监控网1998-1999年监测资料分析[J].中华医院感染学杂志,2000,10(6)：401-404.
[26]李和姐,钱倩健,施晓群等.瑞金医院医院感染与全国医院感染监测比较分析[J].中华医院感染学杂志,2004,14(2)：28-31.
[27]毕重秀.医院感染的危险因素分析[J].长春中医学院学报,1998,14(72)：44.
[28]Laupland KB, Kirkpatrick AW, Church DL, et al. Intensive-care-unit-acquired bloodstream infections in a regional critically ill population[J]. J Hosp Infect,2004,58(2):137-45.
[29]申正义.全球医院感染控制概况[A].预防医学学科发展蓝皮书(2006卷)[C],2006：
[30]Schecker WE. Nosocomial infections in a community hospital:1972 through 1976[J]. Arch Intern Med,1978,138(12):1792-1794.
[31]解放,席修明.医院感染与住院死亡患者关系的调查周[J].中华医院感染学杂志,2000,10(1)：19.
[32]李和姐,顾秋莹.2000年我院医院感染死亡病例调查[J].中国感染控制杂志,2002,12(1)：34-36.
[33]何多多,张玉强,张颖等.230例死亡病历医院感染的分析[J].中华医院感染学杂志,2004,14(12)：37-39.
[34]Emori TG, Banerjee SN, Culver DH, et al. Nosocomial infections in elderly patients in the United States,1986-1990. Natlonal Nosocomial Infections Surveillance system[J]. Am J Med,1991,91(3B):289S-293S.
[35]金中强,吴肇光.术后腹腔感染病人的预后估计(附193例分析)[J].中国实用外科杂志,1997,17(7)：410-412.
[36]魏振满,张文瑾,韩玉坤.肝硬化腹腔感染抗生素应用的流行病学分析[J].中国抗菌药物杂志,1999,24(3)：229-230.
[37]张吉敏,林治辉.肝炎肝硬化合并医院感染临床分析[J].医学综述,1995,1(6)：265-266.
[38]Pittet D, Li N, Wbolson R. Microbiological factors influencing the outcome of nosocomial bloodstream inefctiOns:a 6-year validated, populations-based Model [J]. Clin Infect Dis,1997,24(6):1068-1078.
[39]WisPlinghoff H, Bischoff, T, Tallent, et al. Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study[J]. Clin lnefect Dis,2004,39(3):309-317.
[40]http://www.cdc.gov/nchs/fastats/deaths.htm)National Center for Health Statistics.
[41]刘敏,汪宏.辅助检查在新生儿败血症诊断中的意义[J].田滨州医学院学报,2006,29(4)：317-318.
[42]蔡闯,叶钧强,郭振辉等.9例机械通气过程中气管食管疾的保守治疗[J].中国急救医学,2006,26(7)：546-547.
[43]Laupland KB, Lee H, Gregson DB, et al. Cost of intensive care unit-acquired bloodstream infections [J]. J Hosp Infect,2006,63(2): 124-132.
[44]Graves N. Economics and Preventing hospital-acquired infection[J]. Emerg Infect Dis,2004,10(4):561-566.
[45]周清德,褚德发,高秀华.4种类型医院感染直接经济损失的配比病例对照研究[J].中华流行病学杂志,2001,22(2)：133-136.
[46]卫生部,中医药管理局,总后勤部.抗菌药物临床应用指导原则[S].中华医学杂志,2004,84(21)：1857-1862.
[47]汪复,张婴元.实用抗感染治疗学[M].北京：人民卫生出版社,2004：134-138.
[48]中华医学会外科学分会,中华外科杂志编辑委员会.围手术期预防应用抗菌药物指南.中华外科杂志,2006,44(23)：1594-1596.
[49]张蓓,方洁.抗感染药物联合应用调查与分析[J].药学理论与实践,2004,1(1)：14-16.
[50]胡丽娜.异常产褥[A].见：乐杰主编.妇产科学(第7版)[M].北京：人民卫生出版社,2008：215-221.
[51]Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary[J]. Control Clin Trials, 1996,17(1):1-12
[52]王仲兰,李惠萍.选择性剖宫产术中抗生素冲击量的使用[J].天津医药,1994,22(6)：364-366.
[53]李韶莹,郝琦蓉,张聪琴.剖宫产围手术期预防性应用抗生素的临床分析[J].山西医药杂志,2005,34(2)：107-108.
[54]丁雅娟,张柏岩.剖宫产手术围手术期使用抗生素的临床观察[J].中国妇幼保健,2006,21(4)：575.
[55]施敏莅.剖宫产预防性抗生素应用临床探讨[J].健康大视野·医学分册,2006,14(12)：55-56.
[56]许学先,张蔚,贺翔.192例剖宫产术前应用头孢噻肟钠预防术后感染的观察[J].湖北医科大学学报,1997,18(1)：74-75.
[57]李素英.剖宫产术预防性用抗菌素的临床观察[J].华西医学,1997,12(1)：114-115.
[58]任虹.剖官产术前预防性应用抗生素103例观察[J].皖南医学院学报,1997,16(4)：372-373.
[59]王辉,林阳,卜兰等.合理应用抗菌药对预防剖宫产感染的探讨[J].首都医药,1998,5(6)：25-26.
[60]王晓萍,郭瑞光.达诺欣短程用药预防剖宫产术后感染[J].山东医药医药工业,1998,17(6)：23-24.
[61]关红琼.剖宫产术中使用抗生素预防感染[J].临床医学,2001,21(7)：37-38.
[62]段其华,周合菊.剖宫产术前预防性应用抗生素临床效果分析[J].济宁医学院学报,2003,26(2)：57-58.
[63]朱金艳.剖宫产术预防性应用抗生素不同方法效果观察[J].中国伤残医学,2007,15(2)：36-37.
[64]胡捷.剖宫产术预防性应用抗生素效果分析[J].健康大视野·医学分册,2007,15(4)：25-26.
[65]张怡,刘绛仙,陈鲜明.美福仙预防剖宫产术后感染临床观察[J].湖南医科大学学报,1996,21(6)：561-563.
[66]郑灵芝.抗生素在剖宫产围手术期的应用[J].现代中西医结合杂志,1999,8(7)：1077-1078.
[67]谢灵芝,梁莉萍.56例择期剖宫产预防性使用抗生素的临床观察[J].右江医学,2005,33(1)：38-39.
[68]蒋月霞.术前应用抗生素对预防剖宫产切口感染的临床分析[J].中国保健杂志,2005,13(22)：62.
[69]杨波,张碧英.剖宫产术预防性应用抗生素的效果观察[J].现代中西医结合杂志,2006,15(19)：2646-2647.
[70]刘淑艳.择期剖宫产手术前后预防性应用抗生素的效果比较[J].中国煤炭工业医学杂志,2006,9(9)：959.
[71]陈永梅,朱坤仪.2165例剖宫产术预防使用抗菌药物的临床分析[J].医学创新研究,2007,4(18)：49-50.
[72]毛茶仙.剖宫产术前预防性使用抗生素的临床观察[J].中国药物滥用防治杂志,2007,13(1)：56-57.
[73]马焱,刘荣,程黛丽.剖宫产术前后单次应用抗生素预防术后感染[J].天津药学,1999,11(3)：38-39.
[74]凌静娴.剖宫产围手术期两种不同抗生素使用方法结果的比较[J].交通医学,2001,15(4)：422.
[75]马振芳,孙路明,邢明晖等.短程用药预防选择性剖宫产术后感染[J].上海预防医学杂志,2002,14(4)：166-168.
[76]吕晓虹,康国峰.单剂量头孢噻肟预防剖宫产感染[J].天津医药,2003,31(8)：529-530.
[77]梁立建.头孢呋辛钠术前术后给药防治剖宫产术感染效果比较[J].中国煤炭工业医学杂志,2005,8(7)：742.
[78]黄晓戈,薛芳.剖宫产预防性应用杭生素效果分析[J].实用医技杂志,2005,12(2B)：462-463.
[79]刘秀荣,顾笑梅,李桂荣.剖宫产围术期预防性抗生素的应用[J].华北煤炭医学院学报,2007,9(2)：224-225.
[80]肖永红.《抗菌药物临床应用指导原则》实施中相关问题[J].医药导报,2008,27(1)：4-6.
[81]杨建南,李元宏,李世云等.成都市8所医院460例剖宫产手术围手术期预防用抗菌素药物的调查分析[J].数理医药学杂志,2007,20(5)： 684-685.
[82]Reese RE, Betts RF, Gumustop B. Prophylactic Antibiotics[A]. In:Reese RE, Betts RF, Gumustop B. Handbook of Antibiotics[M]. Philadelphia: Lippincott Williams & Wilkins,2000:247-261.
[83]Kluytmans, JAJW. Infection control in obstetrics[A]. In:R Wenzel, T Brewer, J-P Butzler. A Guide to Infection Control in the Hospital (2nd edition) [M]. Philadelphia:BC Decker Inc,2002:126-129.
[84]徐增祥.重视剖宫产术后感染的诊断及防治[J].前卫医学情报,1992,8(6)：201-205.
[85]方芳.妇产科领域预防性抗生素应用的循证评价[J].实用妇产科杂志,2004,20(1)：7.
[86]孙鹤梅,孙鹤英.宫产术前预防性应用抗生素探讨[J].黑龙江医学杂志,2001,25(4)：309.
[87]Sharma JB, Gupta N, Apparwal P, et al. A survey of obstetricians'practice of using prophylactic antibiotics in vaginal deliveries and caesarean sections[J].J Indian Med Assoc,2008,106(3):147-9.
[88]Colombo DF, Lew JL, Pedersen CA, et al. Optimal timing of ampicillin administration to pregnant women for establishing bactericidal levels in the prophylaxis of Group B Streptococcus [J]. American Journal of Obstetrics and Gynecology,2006,194,466-470.
[89]戴英苗.剖宫产术后预防感染合理用药的观察[J].广东医学院学报,2004,22(5)：524-525.
[90]Ledger WJ. Prophylactic antibiotics in obstetrics-gynecology:a current asset, a future liability[J]? Expert Rev Anti Infect Ther,2006,4(6):957-64
[91]贾公孚,李涛,许莉.药物毒副反应防治手册[M].北京：中国协和医科大学出版社,2004：152-154.
[92]Duff P. Prophylactic antibiotics for cesarean section delivery; a simple cost effective strategy for prevention of postoperative morbidity[J]. Am J Obstet Gynecol,1987,157(4 pt 1):794-798.
[93]Martins AC, Krauss-Silva L. Systematic reviews of antibiotic prophylaxis in cesareans[J]. Cad Saude Publica,2006,22(12):2513-2526.
[94]姜秀仙.剖宫产术后预防性应用不同抗生素的临床分析[J].中国妇幼保健,2004,19(14)：76.
[95]Popovic J, Grujic Z, Sabo A. Influence of pregnancy on ceftriaxone, cefazolin and gentamicin pharmacokinetics in caesarean vs. non-pregnant sectioned women. J Clin Pharm Ther,2007,32(6):595-602.
[96]Robinson HE, Maxwell EL, Prince HM, et al. Cefotetan-induced life-threatening haemolysis[J]. Med J Aust,2006,184(5):251.
[97]Shariatmadar S, Storry JR, Sausais L, et al. Cefotetan-induced immune hemolytic anemia following prophylaxis for cesarean delivery[J]. Immunohematol,2004,20(1):63-66.
[98]Naylor CS, Steele L, Hsi R, et al. Cefotetan-induced hemolysis associated with antibiotic prophylaxis for cesarean delivery[J]. Am J Obstet Gynecol,2000, 182(6):1427-1428.
[99]Viraraghavan R, Chakravarty AG, Soreth J. Cefotetan-induced haemolytic anaemia. A review of 85 cases[J]. Adverse Drug React Toxicol Rev,2002, 21(1-2):101-107.
[100]迟明,李静.第3代头孢菌素的应用与细菌耐药性[J].中国微生态学杂志,2006,18(2)：160-161.
[101]易霞云,郭思健,李宪等.常见革兰阴性杆菌对第3代头孢菌素的耐药率比较[J].中国感染控制杂志,2004,3(1)：24.
[102]蒋潇潇.第3代头孢菌素类药物的不良反应与防治[J].中国药房,2004,15(8)：495.
[103]Opφien HK, Valbφ A, Grinde-Andersen A, et al. Post-cesarean surgical site infections according to CDC standards:rates and risk factors. A prospective cohort study[J]. Acta Obstet Gynecol Scand,2007,86(9):1097-1102.
[104]Lee J, Pai H, Kim KY, et al. Control of extended-spectrum b-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy[J]. JAC, 2007,60(7):629-637.
[105]http://www.whocc.no/atcddd/indexdatabase/
[106]汤光,沈素,李任.抗微生物药物[A].陈新谦,金有豫,汤光主编.新编药物学(第16版)[M].北京：人民卫生出版社,2007：44-136.
[107]邹豪,邵元福,朱才娟等.医院药品DDDs教排序分析的原理及利用[J].中国药房,1996,7(5)：215.
[108]Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility testing[S].16th Informational Supplement M 100-S16,2005, Wayne Pennsylvania:CLSI,2005:100.
[109]Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[S].17th informational supplement M 100-S17. Wayne Pennsylvania:CLSI,2007:100.
[110]吴安华,任南,文细毛等.我国178所医院住院患者日抗菌药物使用率调查[J].中华医院感染学杂志,2002,12(12)：881-884.
[111]吴安华,任南,文细毛.151家医院2003年度住院患者日抗菌药物使用率分析[J].中华流行病学杂志,2005,26(6)：451-454.
[112]张永信.规范抗菌药临床应用的指南——上海市颁布《抗菌药物临床应用指导原则》实施细则[J].上海医药,2007,28(3)：101-103.
[113]王治海,李梅,范惠霞,等.我院2005-2007年抗菌药物利用分析[J].中国药物与临床,2008,8(6)：462-464.
[114]王宇,马金兰,杨瑶.我院2005年-2006年氟喹诺酮类抗菌药物应用分析[J].中国医院用药评价与分析,2008,8(3)：207-208.
[115]Pesic G, Jovic Z, Vasic K. Application of the ATC/DDD methodology to compare antibiotic utilization in two university hospital surgical departments[J]. Medicine and Biology,2005,12(3):174-178.
[116]王治海,李梅,范惠霞等.我院2005-2007年抗菌药物利用分析[J].中国药物与临床,2008,8(6)：462-464.
[117]John JF Jr., Fishman NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital[J]. Clin Infect Dis.1997; 24(3):471-485.
[118]Owens RC, Jr., Fraser GL, Stogsdill P. Antimicrobial stewardship programs as a means to optimize antimicrobial use. Insights from the Society of Infectious Diseases Pharmacists[J]. Pharmacotherapy.2004; 24(7): 896-908.
[119]Paskovaty A, Pflomm JM, Myke N, et al. A multidisciplinary approach to antimicrobial stewardship:evolution into the 21st century[J]. Int J Antimicrob Agents.2005; 25(1):1-10.
[120]Knox K, Lawson W, Dean B, et al. Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist-a UK perspective[J]. J Hosp Infect.2003; 53:85-90.
[121]Feucht CL, Rice LB. An interventional program to improve antibiotic use[J]. Ann Pharmacother.2003; 37(5):646-651.
[122]Beaucaire G. Nosocomial infections. Rev Prat,2003,53(10):1143-51.
[123]汪复.2006年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2008,8(1)：1-9.
[124]Landman D, Chockalingam M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidimeresistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary[J]. Clin Infect Dis.1999; 28(5):1062-1066.
[1]Anonymous. Ten great public health achievements-United States, 1900-1999 [J]. MMWR.1999; 48(12):241-243.
[2]Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century [J]. JAMA.1999; 281(1):61-66.
[3]Davies J. What are antibiotics? Archaic functions for modern activities[J]. Mol Microbiol.1990; 4(8):1227-1232.
[4]Hawkey PM. The origins and molecular basis of antibiotic resistance[J]. BMJ.1998; 317(7159):657-60.
[5]Tenover FC, Hughes JM. The challenges of emerging infectious diseases. Development and spread of multiply-resistant bacterial pathogens[J]. JAMA.1996; 75(4):300-304.
[6]Spellberg B, Powers JH, Brass EP, et al. Trends in antimicrobial drug development:implications for the future[J]. Clin Infect Dis.2004; 38(9): 1279-1286.
[7]Powers JH. Development of drugs for antimicrobial-resistant pathogens[J]. Curr Opin Infect Dis.2003; 16(6):547-551.
[8]Mangili A, Bica I, Snydman DR, et al. Daptomycinresistant, methicillin-resistant Staphylococcus aureus bacteremia[J]. Clin Infect Dis. 2005; 40(7):1058-1060.
[9]Safdar N, Maki DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida[J]. Ann Intern Med.2002; 136(11):834-844.
[10]Monnet DL, Archibald LK, Phillips L, et al. Antimicrobial use and resistance in eight US hospitals:complexities of analysis and modeling. Intensive Care Antimicrobial Resistance Epidemiology Project and National Nosocomial Infections Surveillance System Hospitals[J]. Infect Control Hosp Epidemiol.1998; 19(6):388-394.
[11]Harbarth S, Harris AD, Carmeli Y, et al. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli[J]. Clin Infect Dis.2001; 33(9):1462-1468.
[12]Beezhold DW, Slaughter S, Hayden MK, et al. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia[J]. Clin Infect Dis.1997; 24(4):704-706.
[13]Boyle JF, Soumakis SA, Rendo A, et al. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci[J]. J Clin Microbiol.1993; 31(5):1280-1285.
[14]Rao GG, Ojo F, Kolokithas D. Vancomycin-resistant grampositive cocci: risk factors for faecal carriage[J]. J Hosp Infect.1997; 35(1):63-69.
[15]Lautenbach E, Bilker WB, Brennan PJ. Enterococcal bacteremia:risk factors for vancomycin resistance and predictors of mortality [J]. Infect Control Hosp Epidemiol.1999; 20(5):318-323.
[16]Harbarth S, Cosgrove S, Carmeli Y. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci [J]. Antimicrob Agents Chemother.2002; 46(6):1619-1628.
[17]Rice LB, Lakticova V, Helfand MS, et al. In vitro antienterococcal activity explains associations between exposures to antimicrobial agents and risk of colonization by multiresistant enterococci [J]. J Infect Dis.2004; 190(12): 2162-2166.
[18]Hamilton CD, Drew R, Janning SW, et al. Excessive use of vancomycin:a successful intervention strategy at an academic medical center[J]. Infect Control Hosp Epidemiol.2000; 21(1):42-45.
[19]May AK, Melton SM, McGwin G, et al. Reduction of vancomycin-resistant enterococcal infections by limitation of broad-spectrum cephalosporin use in a trauma and burn intensive care unit[J]. Shock.2000; 14(3):259-64.
[20]Paskovaty A, Pflomm JM, Myke N, et al. A multidisciplinary approach to antimicrobial stewardship:evolution into the 21st century[J]. Int J Antimicrob Agents.2005; 25(1):1-10.
[21]Dziekan G, Hahn A, Thune K, et al. Methicillin-resistant Staphylococcus aureus in a teaching hospital:investigation of nosocomial transmission using a matched case-control study[J].2000; 46(4):263-270.
[22]Graffunder EM, Venezia RA. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials[J]. J Antimicrob Chemother.2002 Jun;49(6):999-1005.
[23]Weber SG, Gold HS, Hooper DC, et al. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients[J]. Emerg Infect Dis.2003; 9(11):1415-1422.
[24]Bisognano C, Vaudaux P, Rohner P, et al. Induction of fibronectin-binding proteins and increased adhesion of quinolone-resistant Staphylococcus aureus by subinhibitory levels of ciprofloxacin[J]. Antimicrob Agents Chemother.2000; 44(6):1428-1437.
[25]Venezia RA, Domaracki BE, Evans AM, et al. Selection of high-level oxacillin resistance in heteroresistant Staphylococcus aureus by fluoroquinolone exposure[J]. J Antimicrob Chemother.2001; 48(3): 375-381.
[26]Harris AD, Karchmer TB, Carmeli Y, et al. Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance:a systematic review[J]. Clin Infect Dis.2001; 32(7):1055-1061.
[27]Rifenburg RP, Paladino JA, Hanson SC, et al. Benchmark analysis of strategies hospitals use to control antimicrobial expenditures[J]. Am J Health Syst Pharm.1996; 53(17):2054-2062.
[28]Sunenshine RH, Liedtke LA, Jernigan DB, et al. Role of infectious diseases consultants in management of antimicrobial use in hospitals[J]. Clin Infect Dis.2004; 38(7):934-938.
[29]Lawton RM, Fridkin SK, Gaynes RP, et al. Practices to improve antimicrobial use at 47 US hospitals:the status of the 1997 SHEA/IDSA position paper recommendations. Society for Healthcare Epidemiology of America/Infectious Diseases Society of America[J]. Infect Control Hosp Epidemiol.2000; 21(4):256-259.
[30]LaRocco A Jr. Concurrent antibiotic review programs-a role for infectious diseases specialists at small community hospitals[J]. Clin Infect Dis.2003; 37(5):742-743.
[31]John JF Jr., Fishman NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital[J]. Clin Infect Dis.1997; 24(3):471-485.
[32]Struelens MJ. Multidisciplinary antimicrobial management teams:the way forward to control antimicrobial resistance in hospitals[J]. Curr Opin Infect Dis.2003; 16(4):305-307.
[33]Chin T, Pipa D. Hospital pharmacists and infectious diseases specialists[J]. Clin Infect Dis.1998; 27(1):228-229.
[34]Carmichael JM, O'Connell MB, Devine B, et al. Collaborative drug therapy management by pharmacists. American College of Clinical Pharmacy [J]. Pharmacotherapy 1997; 17(5):1050-1061.
[35]Gattis WA, Hasselblad V, Whellan DJ, et al. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team:results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study[J]. Arch Intern Med. 1999; 159(16):1939-1945.
[36]Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit[J]. JAMA.1999; 282(3):267-270.
[37]Gross R, Morgan AS, Kinky DE, et al. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes[J]. Clin Infect Dis.2001; 33(3):289-295.
[38]Weller TM, Jamieson CE. The expanding role of the antibiotic pharmacist[J]. J Antimicrob Chemother.2004; 54(2):295-298.
[39]Stratton CW, Ratner H, Johnston PE, et al. Focused microbiologic surveillance by specific hospital unit:practical application and clinical utility[J]. Clin Ther.1993; 15 (Suppl A):12-20
[40]Byl B, Clevenbergh P, Jacobs F, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia[J]. Clin Infect Dis.1999; 29(1):60-66.
[41]National Committee on Clinical Laboratory Standards. Analysis and presentation of cumulative antimicrobial susceptibility test data; approved guideline M-39-A[S]. National Committee on Clinical Laboratory Standards, Wayne, Pa.2002.
[42]Trenholme GM, Kaplan RL, Karakusis PH, et al. Clinical impact of rapid identification and susceptibility testing of bacterial blood culture isolates [J]. J Clin Microbiol.1989; 27(6):1342-1345.
[43]Rice LB. Controlling antibiotic resistance in the ICU:different bacteria, different strategies[J]. Cleve Clin J Med.2003; 70(9):793-800.
[44]Boyce JM, Havill NL, Kohan C, et al. Do infection control measures work for methicillin-resistant Staphylococcus aureus[J]? Infect Control Hosp Epidemiol.2004; 25(5):395-401.
[45]Cooper BS, Stone SP, Kibbler CC, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature [J]. BMJ.2004; 329(7465):533.
[46]Farr BM. Prevention and control of methicillin-resistant Staphylococcus aureus infections [J]. Curr Opin Infect Dis.2004; 17(4):317-322.
[47]Monnet DL. Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use:possible implications for control[J]. Infect Control Hosp Epidemiol.1998;19(8):552-559.
[48]Wachter RM. The end of the beginning:patient safety five years after'To Err Is Human'[M]. Health Affairs 2004; W4:534-545.
[49]Owens RC, Jr., Fraser GL, Stogsdill P. Antimicrobial stewardship programs as a means to optimize antimicrobial use. Insights from the Society of Infectious Diseases Pharmacists[J]. Pharmacotherapy.2004; 24(7): 896-908.
[50]Sbarbaro JA. Can. we influence prescribing patterns[J]? Clin Infect Dis. 2001;33(Suppl 3):S240-244.
[51]Wester CW, Durairaj L, Evans AT, et al. Antibiotic resistance:a survey of physician perceptions[J]. Arch Intern Med.2002; 162(19):2210-2216.
[52]Giblin TB, Sinkowitz-Cochran RL, Harris PL, et al. Clinicians'perceptions of the problem of antimicrobial resistance in health care facilities [J]. Arch Intern Med.2004; 164(15):1662-1668.
[53]Metlay JP, Shea JA, Crossette LB, et al. Tensions in antibiotic prescribing: pitting social concerns against the interests of individual patients[J]. J Gen Intern Med.2002; 17(2):87-94.
[54]Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making[J]. JAMA.1990; 263(4): 549-556.
[55]Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior:an overview of systematic reviews of interventions[J]. Med Care.2001; 39(8 Suppl 2):112-45.
[56]Gross PA, Pujat D. Implementing practice guidelines for appropriate antimicrobial usage:a systematic review[J]. Med Care 2001; 39(8 Suppl 2): 1155-69.
[57]van de Beek D, de Gans J, Spanjaard L, et al. Antibiotic guidelines and antibiotic use in adult bacterial meningitis in The Netherlands [J]. J Antimicrob Chemother.2002; 49(4):661-666.
[58]Girotti MJ, Fodoruk S, Irvine-Meek J, et al. Antibiotic handbook and pre-printed peri operative order forms for surgical antibiotic prophylaxis:do they work[J]? Can J Surg.1990; 33(5):385-388.
[59]Bamberger DM, Dahl SL. Impact of voluntary versus enforced compliance of third-generation cephalosporin use in a teaching hospital [J]. Arch Intern Med.1992; 152(3):554-557.
[60]Switzer GE, Halm EA, Chang CC, et al. Physician awareness and self-reported use of local and national guidelines for community-acquired pneumonia[J]. J. Gen. Intern. Med.2003; 18(10):816-823.
[61]Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership[J]. JAMA.1996; 275(3): 234-240.
[62]Mol PG, Rutten WJ, Gans RO, et al. Adherence barriers to antimicrobial treatment guidelines in teaching hospital[J], The Netherlands Emerg Infect Dis.2004; 10(3):522-525.
[63]Everitt DE, Soumerai SB, Avorn J, et al. Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders[J]. Infect Control Hosp Epidemiol.1990; 11(11):578-583.
[64]McGowan JE, Jr., Finland M. Usage of antibiotics in a general hospital: effect of requiring justification[J]. J Infect Dis.1974; 130(2):165-168.
[65]Craig WA, Uman SJ, Shaw WR, et al. Hospital use of antimicrobial drugs. Survey at 19 hospitals and results of antimicrobial control program[J]. Ann Intern Med.1978; 89(5 Pt 2 Suppl):793-795.
[66]White AC, Jr., Atmar RL, Wilson J, et al. Effects of requiring prior authorization for selected antimicrobials:expenditures, susceptibilities, and clinical outcomes[J]. Clin Infect Dis.1997; 25(2):230-239.
[67]Cannon JP, Silverman RM. A pharmacist-driven antimicrobial approval program at a Veterans Affairs hospital [J]. Am J Health Syst Pharm.2003; 60(13):1358-1362.
[68]Woodward RS, Medoff G, Smith MD, et al. Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital[J]. Am J Med.1987; 83(5):817-823.
[69]Rahal JJ, Urban C, Horn D, et al. Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella[J]. JAMA. 1998; 280(14):1233-1237.
[70]Allegranzi B, Luzzati R, Luzzani A, et al. Impact of antibiotic changes in empirical therapy on antimicrobial resistance in intensive care unit-acquired infections [J].J Hosp Infect.2002; 52(2):136-140.
[71]Burke JP. Antibiotic resistance-squeezing the balloon[J]? JAMA.1998; 280(14):1270-1271.
[72]Piroth L, Aube H, Doise JM, et al. Spread of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae:are beta-lactamase inhibitors of therapeutic value[J]? Clin Infect Dis.1998; 27(1):76-80.
[73]Landman D, Chockalingam M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidimeresistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary[J]. Clin Infect Dis.1999; 28(5):1062-1066.
[74]Lan CK, Hsueh PR, Wong WW, et al. Association of antibiotic utilization measures and reduced incidence of infections with extended-spectrum betalactamase-producing organisms[J]. J Microbiol Immunol Infect.2003; 36(3):182-186.
[75]Rice LB, Eckstein EC, DeVente J, et al. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center[J]. Clin Infect Dis.1996; 23(1):118-124.
[76]Quale J, Landman D, Saurina G, et al. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci[J]. Clin Infect Dis.1996; 23(5):1020-1025.
[77]O'Connor KA, Kingston M, O'Donovan M, et al. Antibiotic prescribing policy and Clostridium difficile diarrhoea[J]. QJM.2004; 97(7):423-429.
[78]Wilcox MH, Freeman J, Fawley W, et al. Long-term surveillance of cefotaxime and piperacillin-tazobactam prescribing and incidence of Clostridium difficile diarrhoea[J]. J Antimicrob Chemother.2004; 54(1): 168-172.
[79]Lautenbach E, LaRosa LA, Marr AM, et al. Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions:impact of progressive restrictions on use of vancomycin and third-generation cephalosporins[J]. Clin Infect Dis.2003; 36(4):440-446.
[80]Fraser GL, Stogsdill P, Dickens JD, Jr., et al. Antibiotic optimization. An evaluation of patient safety and economic outcomes [J]. Arch Intern Med. 1997; 157(15):1689-1694.
[81]Gums JG, Yancey RW, Jr., Hamilton CA, et al. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team [J]. Pharmacotherapy 1999; 19(12):1369-77.
[82]Solomon DH, van Houten L, Glynn RJ, et al. Academic detailing to improve use of broadspectrum antibiotics at an academic medical center[J]. Arch Intern Med.2001; 161(15):1897-1902.
[83]Carling P, Fung T, Killion A, et al. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years [J]. Infect Control Hosp Epidemiol.2003; 24(9):699-706.
[84]Feucht CL, Rice LB. An interventional program to improve antibiotic use[J]. Ann Pharmacother.2003; 37(5):646-651.
[85]Cook PP, Catrou PG, Christie JD, et al. Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram[J]. J Antimicrob Chemother.2004; 53(5):853-859.
[86]Bantar C, Sartori B, Vesco E, et al. A hospitalwide intervention program to optimize the quality of antibiotic use:impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance[J]. Clin Infect Dis.2003; 37(2):180-186.
[87]Gentry CA, Greenfield RA, Slater LN, et al. Outcomes of an antimicrobial control program in a teaching hospital[J]. Am J Health Syst Pharm.2000; 57(3):268-274.
[88]Luna, CM, Vujacich P, Niederman MS, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia[J]. Chest.1997; 111(3):676-685.
[89]Leibovici L, Shraga I, Drucker M, et al. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection[J]. J Intern Med.1998; 244(5):379-386.
[90]Kollef MH, Sherman G, Ward S, et al. Inadequate antimicrobial treatment of infections:a risk factor for hospital mortality among critically ill patients[J]. Chest.1999; 115(2):462-474.
[91]Ibrahim EH, G. Sherman, S. Ward, V. J. Fraser, and M. H. Kollef. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting[J]. Chest.2000; 118(1):146-155.
[92]Lodise TP, McKinnon PS, Swiderski L, et al. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia[J]. Clin Infect Dis.2003; 36(11):1418-1423.
[93]Mac Arthur, RD, Miller M, Albertson T, et al. Adequacy of early empiric antibiotic treatment and survival in severe sepsis:experience from the MONARCS trial[J]. Clin Infect Dis.2004; 38(2):284-288.
[94]Kollef MH. Inadequate antimicrobial treatment:an important determinant of outcome for hospitalized patients[J]. Clin Infect Dis.2000; 31 (Suppl 4): S131-138.
[95]American Thoracic Society/Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilatorassociated, and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med.2005; 171(4):388-416.
[96]Paterson DL, Rice LB. Empirical antibiotic choice for the seriously ill patient:are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive[J]? Clin Infect Dis. 1997; 25(5):1006-1012.
[97]Schentag JJ, Ballow CH, Fritz AL, et al. Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious disease division, and the microbiology laboratory[J]. Diagn Microbiol Infect Dis.1993; 16(3):255-264.
[98]Micek ST, Ward S, Fraser VJ, et al. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia[J]. Chest.2004; 125(5):1791-1799.
[99]Shojania KG, Yokoe D, Platt R, et al. Reducing vancomycin use utilizing a computer guideline:results of a randomized controlled trial[J]. J Am Med Inform Assoc.1998; 5(6):554-562.
[100]Richards MJ, Robertson MB, Dartnell JG, et al. Impact of a web-based antimicrobial approval system on broadspectrum cephalosporin use at a teaching hospital[J]. Med J Aust.2003; 178(8):386-390.
[101]Calfee DP, Brooks J, Zirk NM, et al. A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme[J]. J Hosp Infect.2003; 55(1):26-32.
[102]Glowacki RC, Schwartz DN, Itokazu GS, et al. Antibiotic combinations with redundant antimicrobial spectra:clinical epidemiology and pilot intervention of computer-assisted surveillance[J]. Clin Infect Dis.2003; 37(1):59-64.
[103]Evans RS, Classen DC, Pestotnik SL, et al. Improving empiric antibiotic selection using computer decision support[J]. Arch Intern Med.1994; 154(8):878-884.
[104]Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents [J]. N Engl J Med.1998; 338(4):232-8.
[105]Pestotnik SL, Classen DC, Evans RS, et al. Implementing antibiotic practice guidelines through computer-assisted decision support:clinical and financial outcomes[J]. Ann Intern Med.1996; 124(10):884-90.
[106]Gerding DN. Antimicrobial cycling:lessons learned from the aminoglycoside experience[J]. Infect Control Hosp Epidemiol.2000; 21(1 Suppl):S12-17.
[107]Francetic I, Kalenic S, Huic M, et al. Impact of Aminoglycoside Cycling in Six Tertiary Intensive Care Units:Prospective Longitudinal Interventional Study [J]. Croat Med J.2008; 49(2):207-214.
[108]John JF Jr. Antibiotic cycling:is it ready for prime time[J]? Infect Control Hosp Epidemiol.2000; 21(1):9-11.
[109]Hodges BM, White RL. Antimicrobial cycling:the future or a fad[J]? Ann Pharmacother.2001; 35(10):1224-1232.
[110]Kollef MH. Is there a role for antibiotic cycling in the intensive care unit[J]? Crit Care Med.2001; 29(4 Suppl):N135-142.
[111]Pujol M, Gudiol F. Evidence for antibiotic cycling in control of resistance[J]. Curr Opin Infect Dis.2001; 14(6):711-715.
[112]Fridkin SK. Routine cycling of antimicrobial agents as an infection control measure[J]. Clin Infect Dis.2003; 36(11):1438-1444.
[113]Masterson RG. Antibiotic cycling:more than it might seem[J]? J Antimicrob Chemother.2005; 55(1):1-5.
[114]Brown EM, Nathwani D. Antibiotic cycling or rotation:a systematic review of the evidence of efficacy [J]. J Antimicrob Chemother.2005; 55(1):6-9.
[115]Merz LR, Warren DK, Kollef MH, et al. Effects of an antibiotic cycling program on antibiotic prescribing practices in an intensive care unit[J]. Antimicrob Agents Chemother.2004; 48(8):2861-2865.
[116]Bonhoeffer S, Lipsitch M, Levin BR. Evaluating treatment protocols to prevent antibiotic resistance[J].1997; 94(22):12106-12111.
[117]Bergstrom CT, Lo M, Lipsitch M. Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals[J].2004; 101(36):13285-90.
[118]Lipsitch M, Levin BR. The population dynamics of antimicrobial chemotherapy [J]. Antimicrob. Agents Chemother.1997; 41(2):363-673.
[119]Austin DJ, Kristinsson KG, Anderson RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance[J]. Proc Natl Acad Sci USA.1999; 96(3): 1152-1156.
[120]Monnet DL, Archibald LK, Phillips L, et al. Antimicrobial use and resistance in eight US hospitals:complexities of analysis and modeling. Intensive Care Antimicrobial Resistance Epidemiology Project and National Nosocomial Infections Surveillance System Hospitals[J]. Infect Control Hosp Epidemiol.1998; 19(6):388-394.
[121]Crowcroft NS, Ronveaux O, Monnet DL, et al. Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals[J]. Infect Control Hosp Epidemiol.1999; 20(1):31-36.
[122]Fridkin SK, Steward CD, Edwards JR, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals:project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals[J]. Clin Infect Dis.1999; 29(2):245-252.
[123]Fridkin SK, Edwards JR, Courval JM, et al. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units[J]. Ann Intern Med.2001; 135(3):175-183.
[124]Zervos MJ, Hershberger E, Nicolau DP, et al. Relationship between fluoroquinolone use and changes in susceptibility to fluoroquinolones of selected pathogens in 10 United States teaching hospitals,1991-2000[J]. Clin Infect Dis.2003; 37(12):1643-1648.
[125]Bhavnani SM, Hammel JP, Jones RN, et al. Relationship between increased levofloxacin use and decreased susceptibility of Streptococcus pneumoniae in the United States[J]. Diagn Microbiol Infect Dis.2005; 51(1):31-37.
[126]Lopez-Lozano JM, Monnet DL, Yague A, et al. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use:a time series analysis[J]. Int J Antimicrob Agents.2000; 14(1):21-31.
[127]Monnet DL, Lopez-Lozan o JM, Campillos P, et al. Making sense of antimicrobial use and resistance surveillance data:application of ARIMA and transfer function models[J]. Clin Microbiol Infect.2001; 7 (Suppl 5): 29-36.
[128]Monnet DL, MacKenzie FM, Lopez-Lozano JM, et al. Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000[J]. Emerg Infect Dis.2004; 10(8):1432-1441.
[129]Loeb, M. Antibiotic use in long-term-care facilities:many unanswered questions[J]. Infect Control Hosp Epidemiol.2000; 21(10):680-683.
[130]Capitano B, Nicolau DP. Evolving epidemiology and cost of resistance to antimicrobial agents in long-term care facilities[J]. J Am Med Dir Assoc. 2003; 4(3 Suppl):S90-99..
[131]Viray M, Linkin D, Maslow JN, et al. Longitudinal trends in antimicrobial susceptibilities across long-term-care facilities:emergence of fluoroquinolone resi stance [J]. Infect Control Hosp Epidemiol.2005; 26(1): 56-62.
[132]Chin T. Doctors pull plug on paperless system[N]. Am Med News.2003; 46:5-8.
[133]Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes:a systematic review[J]. JAMA.2005;293(10):1223-1238.
[134]Madaras-Kelly K. Optimizing antibiotic use in hospitals:the role of population-based antibiotic surveillance in limiting antibiotic resistance Insights from the society of infectious diseases pharmacists[J]. Pharmacotherapy.2003; 23(12):1627-1633.
[135]Bhavnani SM. Benchmarking in health-system pharmacy:current research and practical applications [J]. Am J Health Syst Pharm.2000; 57 (Suppl 2): S13-20.
[2]Mayon-White RT et al. An international survey of the prevalence of hospital-acquired infection[J]. J Hosp Infect,1988,11 (Suppl A):43-48.
[3]Plowman R et al. The socio-economic burden of hospital-acquired infection. Euro Surveill,2000,5(4):49-50.
[4]陈进华,施长泰,汪能平.神经外科医院感染经济损失的病例对照研究[J].中华医院感染学杂志,1999,9(2)：87-88.
[5]Chen YY, Chou YC, Chou P. Impact of nosocomial nfection on cost of illness and length of stay in intensive care units[J]. Infect Control Hosp Epidemiol,2005,26(3):281-287.
[6]Wenzel RP. The economics of nosocomial infections[J]. J Hosp Infect, 1995,31(2):79-87.
[7]Kirkland KB et al. The impact of surgical-site infections in the 1990's: attributable mortality, excess length of hospitalization and extra costs[J]. Infect Control Hosp Epidemiol,1999,20(11):725-730.
[8]刘振声,金大鹏,陈增辉.医院感染管理学[M].北京：军事医学科学出版社,2000：
[9]Ponce-de-Leon S. The needs of developing countries and the resources required. J Hosp Infect,1991,18 (Suppl):376-381.
[10]Koln L, Colrigan J, Donaldson M. To err is human:buiding a safer health System[M]. Washington DC:Institute of Medicine National Academy Press,1999:
[11]Plowman R, Graves N, Crifill MAS, et al. The rate and cost of hospital-aquired infections occurring in patieins admitted to selected specialies of a disirtct general hospital in England and the national burden imposed[J]. Hosp Infect,2001; 47(3):198-209.
[12]胡必杰.当前医院感染研究领域中的热点问题明[J].上海护理,2003,3(2)：46-65.
[13]齐晓红,区少珍.ICU患者医院感染危险因素监测分析[J].中国感染控制杂志,2005,4(2)：50-52.
[14]任玲,周宏,茅一平等.神经外科手术患者医院感染目标性监测及感染相关危险因素分析[J].中国感染控制杂志,2006,16(2)：29-32.
[15]邢华燕,张卫东,范秋萍等.某医院1993年至200年下呼吸道医院感染分布及其危险因素监测[J].郑州大学学报(医学版),2004,39(4)：636-640.
[16]WHO. WHO Global Strategy for Containment of Antimicrobial Resistance[R]. Geneva:World Health Organization,2001:
[17]Struelens MJ. The epidemiology of antimicrobial resistance in hospital-acquired infections:problems and possible solutions[J]. BMJ, 1998,317:652-654.
[18]Centers for Disease Control and Prevention. A public health action plan to combat antimicrobial resistance. Atlanta:Centers for Disease Control and Prevention,2001:
[19]Department of Health. United Kingdom antimicrobial resistance strategy and action plan[S]. London:UK Department of Health,2000:
[20]World Health Organization. W.H.O. global strategy for containment of antimicrobial resistance[R]. Geneva:World Health Organization,2001:
[21]O'Brien TF. The global epidemic nature of antimicrobial resistance and the need to monitor and manage it locally[J]. Clin Infect Dis,1997,24 (Suppl 1):S2-8.
[22]O'Brien TF. Emergence, spread, and environmental effect of antimicrobial resistance:how use of an antimicrobial anywhere can increase resistance to any antimicrobial anywhere else[J]. Clin Infect Dis,2002,34 (Suppl 3): S78-84.
[23]Wenzel RP. National and international nosocomial infection surveillance system[A]. In:Wenzel RP, ed. Prevention and control of nosocomial infections[M]. Pennsylvania:Pillincott Williams & Wilkins,2003:109-119.
[24]陈清.医院感染的流行病学进展[J].新医学,2006,37(7)：430-433.
[25]吴安华,任南.全国医院感染监控网1998-1999年监测资料分析[J].中华医院感染学杂志,2000,10(6)：401-404.
[26]李和姐,钱倩健,施晓群等.瑞金医院医院感染与全国医院感染监测比较分析[J].中华医院感染学杂志,2004,14(2)：28-31.
[27]毕重秀.医院感染的危险因素分析[J].长春中医学院学报,1998,14(72)：44.
[28]Laupland KB, Kirkpatrick AW, Church DL, et al. Intensive-care-unit-acquired bloodstream infections in a regional critically ill population[J]. J Hosp Infect,2004,58(2):137-45.
[29]申正义.全球医院感染控制概况[A].预防医学学科发展蓝皮书(2006卷)[C],2006：
[30]Schecker WE. Nosocomial infections in a community hospital:1972 through 1976[J]. Arch Intern Med,1978,138(12):1792-1794.
[31]解放,席修明.医院感染与住院死亡患者关系的调查周[J].中华医院感染学杂志,2000,10(1)：19.
[32]李和姐,顾秋莹.2000年我院医院感染死亡病例调查[J].中国感染控制杂志,2002,12(1)：34-36.
[33]何多多,张玉强,张颖等.230例死亡病历医院感染的分析[J].中华医院感染学杂志,2004,14(12)：37-39.
[34]Emori TG, Banerjee SN, Culver DH, et al. Nosocomial infections in elderly patients in the United States,1986-1990. Natlonal Nosocomial Infections Surveillance system[J]. Am J Med,1991,91(3B):289S-293S.
[35]金中强,吴肇光.术后腹腔感染病人的预后估计(附193例分析)[J].中国实用外科杂志,1997,17(7)：410-412.
[36]魏振满,张文瑾,韩玉坤.肝硬化腹腔感染抗生素应用的流行病学分析[J].中国抗菌药物杂志,1999,24(3)：229-230.
[37]张吉敏,林治辉.肝炎肝硬化合并医院感染临床分析[J].医学综述,1995,1(6)：265-266.
[38]Pittet D, Li N, Wbolson R. Microbiological factors influencing the outcome of nosocomial bloodstream inefctiOns:a 6-year validated, populations-based Model [J]. Clin Infect Dis,1997,24(6):1068-1078.
[39]WisPlinghoff H, Bischoff, T, Tallent, et al. Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study[J]. Clin lnefect Dis,2004,39(3):309-317.
[40]http://www.cdc.gov/nchs/fastats/deaths.htm)National Center for Health Statistics.
[41]刘敏,汪宏.辅助检查在新生儿败血症诊断中的意义[J].田滨州医学院学报,2006,29(4)：317-318.
[42]蔡闯,叶钧强,郭振辉等.9例机械通气过程中气管食管疾的保守治疗[J].中国急救医学,2006,26(7)：546-547.
[43]Laupland KB, Lee H, Gregson DB, et al. Cost of intensive care unit-acquired bloodstream infections [J]. J Hosp Infect,2006,63(2): 124-132.
[44]Graves N. Economics and Preventing hospital-acquired infection[J]. Emerg Infect Dis,2004,10(4):561-566.
[45]周清德,褚德发,高秀华.4种类型医院感染直接经济损失的配比病例对照研究[J].中华流行病学杂志,2001,22(2)：133-136.
[46]卫生部,中医药管理局,总后勤部.抗菌药物临床应用指导原则[S].中华医学杂志,2004,84(21)：1857-1862.
[47]汪复,张婴元.实用抗感染治疗学[M].北京：人民卫生出版社,2004：134-138.
[48]中华医学会外科学分会,中华外科杂志编辑委员会.围手术期预防应用抗菌药物指南.中华外科杂志,2006,44(23)：1594-1596.
[49]张蓓,方洁.抗感染药物联合应用调查与分析[J].药学理论与实践,2004,1(1)：14-16.
[50]胡丽娜.异常产褥[A].见：乐杰主编.妇产科学(第7版)[M].北京：人民卫生出版社,2008：215-221.
[51]Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary[J]. Control Clin Trials, 1996,17(1):1-12
[52]王仲兰,李惠萍.选择性剖宫产术中抗生素冲击量的使用[J].天津医药,1994,22(6)：364-366.
[53]李韶莹,郝琦蓉,张聪琴.剖宫产围手术期预防性应用抗生素的临床分析[J].山西医药杂志,2005,34(2)：107-108.
[54]丁雅娟,张柏岩.剖宫产手术围手术期使用抗生素的临床观察[J].中国妇幼保健,2006,21(4)：575.
[55]施敏莅.剖宫产预防性抗生素应用临床探讨[J].健康大视野·医学分册,2006,14(12)：55-56.
[56]许学先,张蔚,贺翔.192例剖宫产术前应用头孢噻肟钠预防术后感染的观察[J].湖北医科大学学报,1997,18(1)：74-75.
[57]李素英.剖宫产术预防性用抗菌素的临床观察[J].华西医学,1997,12(1)：114-115.
[58]任虹.剖官产术前预防性应用抗生素103例观察[J].皖南医学院学报,1997,16(4)：372-373.
[59]王辉,林阳,卜兰等.合理应用抗菌药对预防剖宫产感染的探讨[J].首都医药,1998,5(6)：25-26.
[60]王晓萍,郭瑞光.达诺欣短程用药预防剖宫产术后感染[J].山东医药医药工业,1998,17(6)：23-24.
[61]关红琼.剖宫产术中使用抗生素预防感染[J].临床医学,2001,21(7)：37-38.
[62]段其华,周合菊.剖宫产术前预防性应用抗生素临床效果分析[J].济宁医学院学报,2003,26(2)：57-58.
[63]朱金艳.剖宫产术预防性应用抗生素不同方法效果观察[J].中国伤残医学,2007,15(2)：36-37.
[64]胡捷.剖宫产术预防性应用抗生素效果分析[J].健康大视野·医学分册,2007,15(4)：25-26.
[65]张怡,刘绛仙,陈鲜明.美福仙预防剖宫产术后感染临床观察[J].湖南医科大学学报,1996,21(6)：561-563.
[66]郑灵芝.抗生素在剖宫产围手术期的应用[J].现代中西医结合杂志,1999,8(7)：1077-1078.
[67]谢灵芝,梁莉萍.56例择期剖宫产预防性使用抗生素的临床观察[J].右江医学,2005,33(1)：38-39.
[68]蒋月霞.术前应用抗生素对预防剖宫产切口感染的临床分析[J].中国保健杂志,2005,13(22)：62.
[69]杨波,张碧英.剖宫产术预防性应用抗生素的效果观察[J].现代中西医结合杂志,2006,15(19)：2646-2647.
[70]刘淑艳.择期剖宫产手术前后预防性应用抗生素的效果比较[J].中国煤炭工业医学杂志,2006,9(9)：959.
[71]陈永梅,朱坤仪.2165例剖宫产术预防使用抗菌药物的临床分析[J].医学创新研究,2007,4(18)：49-50.
[72]毛茶仙.剖宫产术前预防性使用抗生素的临床观察[J].中国药物滥用防治杂志,2007,13(1)：56-57.
[73]马焱,刘荣,程黛丽.剖宫产术前后单次应用抗生素预防术后感染[J].天津药学,1999,11(3)：38-39.
[74]凌静娴.剖宫产围手术期两种不同抗生素使用方法结果的比较[J].交通医学,2001,15(4)：422.
[75]马振芳,孙路明,邢明晖等.短程用药预防选择性剖宫产术后感染[J].上海预防医学杂志,2002,14(4)：166-168.
[76]吕晓虹,康国峰.单剂量头孢噻肟预防剖宫产感染[J].天津医药,2003,31(8)：529-530.
[77]梁立建.头孢呋辛钠术前术后给药防治剖宫产术感染效果比较[J].中国煤炭工业医学杂志,2005,8(7)：742.
[78]黄晓戈,薛芳.剖宫产预防性应用杭生素效果分析[J].实用医技杂志,2005,12(2B)：462-463.
[79]刘秀荣,顾笑梅,李桂荣.剖宫产围术期预防性抗生素的应用[J].华北煤炭医学院学报,2007,9(2)：224-225.
[80]肖永红.《抗菌药物临床应用指导原则》实施中相关问题[J].医药导报,2008,27(1)：4-6.
[81]杨建南,李元宏,李世云等.成都市8所医院460例剖宫产手术围手术期预防用抗菌素药物的调查分析[J].数理医药学杂志,2007,20(5)： 684-685.
[82]Reese RE, Betts RF, Gumustop B. Prophylactic Antibiotics[A]. In:Reese RE, Betts RF, Gumustop B. Handbook of Antibiotics[M]. Philadelphia: Lippincott Williams & Wilkins,2000:247-261.
[83]Kluytmans, JAJW. Infection control in obstetrics[A]. In:R Wenzel, T Brewer, J-P Butzler. A Guide to Infection Control in the Hospital (2nd edition) [M]. Philadelphia:BC Decker Inc,2002:126-129.
[84]徐增祥.重视剖宫产术后感染的诊断及防治[J].前卫医学情报,1992,8(6)：201-205.
[85]方芳.妇产科领域预防性抗生素应用的循证评价[J].实用妇产科杂志,2004,20(1)：7.
[86]孙鹤梅,孙鹤英.宫产术前预防性应用抗生素探讨[J].黑龙江医学杂志,2001,25(4)：309.
[87]Sharma JB, Gupta N, Apparwal P, et al. A survey of obstetricians'practice of using prophylactic antibiotics in vaginal deliveries and caesarean sections[J].J Indian Med Assoc,2008,106(3):147-9.
[88]Colombo DF, Lew JL, Pedersen CA, et al. Optimal timing of ampicillin administration to pregnant women for establishing bactericidal levels in the prophylaxis of Group B Streptococcus [J]. American Journal of Obstetrics and Gynecology,2006,194,466-470.
[89]戴英苗.剖宫产术后预防感染合理用药的观察[J].广东医学院学报,2004,22(5)：524-525.
[90]Ledger WJ. Prophylactic antibiotics in obstetrics-gynecology:a current asset, a future liability[J]? Expert Rev Anti Infect Ther,2006,4(6):957-64
[91]贾公孚,李涛,许莉.药物毒副反应防治手册[M].北京：中国协和医科大学出版社,2004：152-154.
[92]Duff P. Prophylactic antibiotics for cesarean section delivery; a simple cost effective strategy for prevention of postoperative morbidity[J]. Am J Obstet Gynecol,1987,157(4 pt 1):794-798.
[93]Martins AC, Krauss-Silva L. Systematic reviews of antibiotic prophylaxis in cesareans[J]. Cad Saude Publica,2006,22(12):2513-2526.
[94]姜秀仙.剖宫产术后预防性应用不同抗生素的临床分析[J].中国妇幼保健,2004,19(14)：76.
[95]Popovic J, Grujic Z, Sabo A. Influence of pregnancy on ceftriaxone, cefazolin and gentamicin pharmacokinetics in caesarean vs. non-pregnant sectioned women. J Clin Pharm Ther,2007,32(6):595-602.
[96]Robinson HE, Maxwell EL, Prince HM, et al. Cefotetan-induced life-threatening haemolysis[J]. Med J Aust,2006,184(5):251.
[97]Shariatmadar S, Storry JR, Sausais L, et al. Cefotetan-induced immune hemolytic anemia following prophylaxis for cesarean delivery[J]. Immunohematol,2004,20(1):63-66.
[98]Naylor CS, Steele L, Hsi R, et al. Cefotetan-induced hemolysis associated with antibiotic prophylaxis for cesarean delivery[J]. Am J Obstet Gynecol,2000, 182(6):1427-1428.
[99]Viraraghavan R, Chakravarty AG, Soreth J. Cefotetan-induced haemolytic anaemia. A review of 85 cases[J]. Adverse Drug React Toxicol Rev,2002, 21(1-2):101-107.
[100]迟明,李静.第3代头孢菌素的应用与细菌耐药性[J].中国微生态学杂志,2006,18(2)：160-161.
[101]易霞云,郭思健,李宪等.常见革兰阴性杆菌对第3代头孢菌素的耐药率比较[J].中国感染控制杂志,2004,3(1)：24.
[102]蒋潇潇.第3代头孢菌素类药物的不良反应与防治[J].中国药房,2004,15(8)：495.
[103]Opφien HK, Valbφ A, Grinde-Andersen A, et al. Post-cesarean surgical site infections according to CDC standards:rates and risk factors. A prospective cohort study[J]. Acta Obstet Gynecol Scand,2007,86(9):1097-1102.
[104]Lee J, Pai H, Kim KY, et al. Control of extended-spectrum b-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy[J]. JAC, 2007,60(7):629-637.
[105]http://www.whocc.no/atcddd/indexdatabase/
[106]汤光,沈素,李任.抗微生物药物[A].陈新谦,金有豫,汤光主编.新编药物学(第16版)[M].北京：人民卫生出版社,2007：44-136.
[107]邹豪,邵元福,朱才娟等.医院药品DDDs教排序分析的原理及利用[J].中国药房,1996,7(5)：215.
[108]Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility testing[S].16th Informational Supplement M 100-S16,2005, Wayne Pennsylvania:CLSI,2005:100.
[109]Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing[S].17th informational supplement M 100-S17. Wayne Pennsylvania:CLSI,2007:100.
[110]吴安华,任南,文细毛等.我国178所医院住院患者日抗菌药物使用率调查[J].中华医院感染学杂志,2002,12(12)：881-884.
[111]吴安华,任南,文细毛.151家医院2003年度住院患者日抗菌药物使用率分析[J].中华流行病学杂志,2005,26(6)：451-454.
[112]张永信.规范抗菌药临床应用的指南——上海市颁布《抗菌药物临床应用指导原则》实施细则[J].上海医药,2007,28(3)：101-103.
[113]王治海,李梅,范惠霞,等.我院2005-2007年抗菌药物利用分析[J].中国药物与临床,2008,8(6)：462-464.
[114]王宇,马金兰,杨瑶.我院2005年-2006年氟喹诺酮类抗菌药物应用分析[J].中国医院用药评价与分析,2008,8(3)：207-208.
[115]Pesic G, Jovic Z, Vasic K. Application of the ATC/DDD methodology to compare antibiotic utilization in two university hospital surgical departments[J]. Medicine and Biology,2005,12(3):174-178.
[116]王治海,李梅,范惠霞等.我院2005-2007年抗菌药物利用分析[J].中国药物与临床,2008,8(6)：462-464.
[117]John JF Jr., Fishman NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital[J]. Clin Infect Dis.1997; 24(3):471-485.
[118]Owens RC, Jr., Fraser GL, Stogsdill P. Antimicrobial stewardship programs as a means to optimize antimicrobial use. Insights from the Society of Infectious Diseases Pharmacists[J]. Pharmacotherapy.2004; 24(7): 896-908.
[119]Paskovaty A, Pflomm JM, Myke N, et al. A multidisciplinary approach to antimicrobial stewardship:evolution into the 21st century[J]. Int J Antimicrob Agents.2005; 25(1):1-10.
[120]Knox K, Lawson W, Dean B, et al. Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist-a UK perspective[J]. J Hosp Infect.2003; 53:85-90.
[121]Feucht CL, Rice LB. An interventional program to improve antibiotic use[J]. Ann Pharmacother.2003; 37(5):646-651.
[122]Beaucaire G. Nosocomial infections. Rev Prat,2003,53(10):1143-51.
[123]汪复.2006年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2008,8(1)：1-9.
[124]Landman D, Chockalingam M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidimeresistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary[J]. Clin Infect Dis.1999; 28(5):1062-1066.
[1]Anonymous. Ten great public health achievements-United States, 1900-1999 [J]. MMWR.1999; 48(12):241-243.
[2]Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century [J]. JAMA.1999; 281(1):61-66.
[3]Davies J. What are antibiotics? Archaic functions for modern activities[J]. Mol Microbiol.1990; 4(8):1227-1232.
[4]Hawkey PM. The origins and molecular basis of antibiotic resistance[J]. BMJ.1998; 317(7159):657-60.
[5]Tenover FC, Hughes JM. The challenges of emerging infectious diseases. Development and spread of multiply-resistant bacterial pathogens[J]. JAMA.1996; 75(4):300-304.
[6]Spellberg B, Powers JH, Brass EP, et al. Trends in antimicrobial drug development:implications for the future[J]. Clin Infect Dis.2004; 38(9): 1279-1286.
[7]Powers JH. Development of drugs for antimicrobial-resistant pathogens[J]. Curr Opin Infect Dis.2003; 16(6):547-551.
[8]Mangili A, Bica I, Snydman DR, et al. Daptomycinresistant, methicillin-resistant Staphylococcus aureus bacteremia[J]. Clin Infect Dis. 2005; 40(7):1058-1060.
[9]Safdar N, Maki DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida[J]. Ann Intern Med.2002; 136(11):834-844.
[10]Monnet DL, Archibald LK, Phillips L, et al. Antimicrobial use and resistance in eight US hospitals:complexities of analysis and modeling. Intensive Care Antimicrobial Resistance Epidemiology Project and National Nosocomial Infections Surveillance System Hospitals[J]. Infect Control Hosp Epidemiol.1998; 19(6):388-394.
[11]Harbarth S, Harris AD, Carmeli Y, et al. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli[J]. Clin Infect Dis.2001; 33(9):1462-1468.
[12]Beezhold DW, Slaughter S, Hayden MK, et al. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia[J]. Clin Infect Dis.1997; 24(4):704-706.
[13]Boyle JF, Soumakis SA, Rendo A, et al. Epidemiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant enterococci[J]. J Clin Microbiol.1993; 31(5):1280-1285.
[14]Rao GG, Ojo F, Kolokithas D. Vancomycin-resistant grampositive cocci: risk factors for faecal carriage[J]. J Hosp Infect.1997; 35(1):63-69.
[15]Lautenbach E, Bilker WB, Brennan PJ. Enterococcal bacteremia:risk factors for vancomycin resistance and predictors of mortality [J]. Infect Control Hosp Epidemiol.1999; 20(5):318-323.
[16]Harbarth S, Cosgrove S, Carmeli Y. Effects of antibiotics on nosocomial epidemiology of vancomycin-resistant enterococci [J]. Antimicrob Agents Chemother.2002; 46(6):1619-1628.
[17]Rice LB, Lakticova V, Helfand MS, et al. In vitro antienterococcal activity explains associations between exposures to antimicrobial agents and risk of colonization by multiresistant enterococci [J]. J Infect Dis.2004; 190(12): 2162-2166.
[18]Hamilton CD, Drew R, Janning SW, et al. Excessive use of vancomycin:a successful intervention strategy at an academic medical center[J]. Infect Control Hosp Epidemiol.2000; 21(1):42-45.
[19]May AK, Melton SM, McGwin G, et al. Reduction of vancomycin-resistant enterococcal infections by limitation of broad-spectrum cephalosporin use in a trauma and burn intensive care unit[J]. Shock.2000; 14(3):259-64.
[20]Paskovaty A, Pflomm JM, Myke N, et al. A multidisciplinary approach to antimicrobial stewardship:evolution into the 21st century[J]. Int J Antimicrob Agents.2005; 25(1):1-10.
[21]Dziekan G, Hahn A, Thune K, et al. Methicillin-resistant Staphylococcus aureus in a teaching hospital:investigation of nosocomial transmission using a matched case-control study[J].2000; 46(4):263-270.
[22]Graffunder EM, Venezia RA. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials[J]. J Antimicrob Chemother.2002 Jun;49(6):999-1005.
[23]Weber SG, Gold HS, Hooper DC, et al. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients[J]. Emerg Infect Dis.2003; 9(11):1415-1422.
[24]Bisognano C, Vaudaux P, Rohner P, et al. Induction of fibronectin-binding proteins and increased adhesion of quinolone-resistant Staphylococcus aureus by subinhibitory levels of ciprofloxacin[J]. Antimicrob Agents Chemother.2000; 44(6):1428-1437.
[25]Venezia RA, Domaracki BE, Evans AM, et al. Selection of high-level oxacillin resistance in heteroresistant Staphylococcus aureus by fluoroquinolone exposure[J]. J Antimicrob Chemother.2001; 48(3): 375-381.
[26]Harris AD, Karchmer TB, Carmeli Y, et al. Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance:a systematic review[J]. Clin Infect Dis.2001; 32(7):1055-1061.
[27]Rifenburg RP, Paladino JA, Hanson SC, et al. Benchmark analysis of strategies hospitals use to control antimicrobial expenditures[J]. Am J Health Syst Pharm.1996; 53(17):2054-2062.
[28]Sunenshine RH, Liedtke LA, Jernigan DB, et al. Role of infectious diseases consultants in management of antimicrobial use in hospitals[J]. Clin Infect Dis.2004; 38(7):934-938.
[29]Lawton RM, Fridkin SK, Gaynes RP, et al. Practices to improve antimicrobial use at 47 US hospitals:the status of the 1997 SHEA/IDSA position paper recommendations. Society for Healthcare Epidemiology of America/Infectious Diseases Society of America[J]. Infect Control Hosp Epidemiol.2000; 21(4):256-259.
[30]LaRocco A Jr. Concurrent antibiotic review programs-a role for infectious diseases specialists at small community hospitals[J]. Clin Infect Dis.2003; 37(5):742-743.
[31]John JF Jr., Fishman NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital[J]. Clin Infect Dis.1997; 24(3):471-485.
[32]Struelens MJ. Multidisciplinary antimicrobial management teams:the way forward to control antimicrobial resistance in hospitals[J]. Curr Opin Infect Dis.2003; 16(4):305-307.
[33]Chin T, Pipa D. Hospital pharmacists and infectious diseases specialists[J]. Clin Infect Dis.1998; 27(1):228-229.
[34]Carmichael JM, O'Connell MB, Devine B, et al. Collaborative drug therapy management by pharmacists. American College of Clinical Pharmacy [J]. Pharmacotherapy 1997; 17(5):1050-1061.
[35]Gattis WA, Hasselblad V, Whellan DJ, et al. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team:results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study[J]. Arch Intern Med. 1999; 159(16):1939-1945.
[36]Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit[J]. JAMA.1999; 282(3):267-270.
[37]Gross R, Morgan AS, Kinky DE, et al. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes[J]. Clin Infect Dis.2001; 33(3):289-295.
[38]Weller TM, Jamieson CE. The expanding role of the antibiotic pharmacist[J]. J Antimicrob Chemother.2004; 54(2):295-298.
[39]Stratton CW, Ratner H, Johnston PE, et al. Focused microbiologic surveillance by specific hospital unit:practical application and clinical utility[J]. Clin Ther.1993; 15 (Suppl A):12-20
[40]Byl B, Clevenbergh P, Jacobs F, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia[J]. Clin Infect Dis.1999; 29(1):60-66.
[41]National Committee on Clinical Laboratory Standards. Analysis and presentation of cumulative antimicrobial susceptibility test data; approved guideline M-39-A[S]. National Committee on Clinical Laboratory Standards, Wayne, Pa.2002.
[42]Trenholme GM, Kaplan RL, Karakusis PH, et al. Clinical impact of rapid identification and susceptibility testing of bacterial blood culture isolates [J]. J Clin Microbiol.1989; 27(6):1342-1345.
[43]Rice LB. Controlling antibiotic resistance in the ICU:different bacteria, different strategies[J]. Cleve Clin J Med.2003; 70(9):793-800.
[44]Boyce JM, Havill NL, Kohan C, et al. Do infection control measures work for methicillin-resistant Staphylococcus aureus[J]? Infect Control Hosp Epidemiol.2004; 25(5):395-401.
[45]Cooper BS, Stone SP, Kibbler CC, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature [J]. BMJ.2004; 329(7465):533.
[46]Farr BM. Prevention and control of methicillin-resistant Staphylococcus aureus infections [J]. Curr Opin Infect Dis.2004; 17(4):317-322.
[47]Monnet DL. Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use:possible implications for control[J]. Infect Control Hosp Epidemiol.1998;19(8):552-559.
[48]Wachter RM. The end of the beginning:patient safety five years after'To Err Is Human'[M]. Health Affairs 2004; W4:534-545.
[49]Owens RC, Jr., Fraser GL, Stogsdill P. Antimicrobial stewardship programs as a means to optimize antimicrobial use. Insights from the Society of Infectious Diseases Pharmacists[J]. Pharmacotherapy.2004; 24(7): 896-908.
[50]Sbarbaro JA. Can. we influence prescribing patterns[J]? Clin Infect Dis. 2001;33(Suppl 3):S240-244.
[51]Wester CW, Durairaj L, Evans AT, et al. Antibiotic resistance:a survey of physician perceptions[J]. Arch Intern Med.2002; 162(19):2210-2216.
[52]Giblin TB, Sinkowitz-Cochran RL, Harris PL, et al. Clinicians'perceptions of the problem of antimicrobial resistance in health care facilities [J]. Arch Intern Med.2004; 164(15):1662-1668.
[53]Metlay JP, Shea JA, Crossette LB, et al. Tensions in antibiotic prescribing: pitting social concerns against the interests of individual patients[J]. J Gen Intern Med.2002; 17(2):87-94.
[54]Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making[J]. JAMA.1990; 263(4): 549-556.
[55]Grimshaw JM, Shirran L, Thomas R, et al. Changing provider behavior:an overview of systematic reviews of interventions[J]. Med Care.2001; 39(8 Suppl 2):112-45.
[56]Gross PA, Pujat D. Implementing practice guidelines for appropriate antimicrobial usage:a systematic review[J]. Med Care 2001; 39(8 Suppl 2): 1155-69.
[57]van de Beek D, de Gans J, Spanjaard L, et al. Antibiotic guidelines and antibiotic use in adult bacterial meningitis in The Netherlands [J]. J Antimicrob Chemother.2002; 49(4):661-666.
[58]Girotti MJ, Fodoruk S, Irvine-Meek J, et al. Antibiotic handbook and pre-printed peri operative order forms for surgical antibiotic prophylaxis:do they work[J]? Can J Surg.1990; 33(5):385-388.
[59]Bamberger DM, Dahl SL. Impact of voluntary versus enforced compliance of third-generation cephalosporin use in a teaching hospital [J]. Arch Intern Med.1992; 152(3):554-557.
[60]Switzer GE, Halm EA, Chang CC, et al. Physician awareness and self-reported use of local and national guidelines for community-acquired pneumonia[J]. J. Gen. Intern. Med.2003; 18(10):816-823.
[61]Goldmann DA, Weinstein RA, Wenzel RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership[J]. JAMA.1996; 275(3): 234-240.
[62]Mol PG, Rutten WJ, Gans RO, et al. Adherence barriers to antimicrobial treatment guidelines in teaching hospital[J], The Netherlands Emerg Infect Dis.2004; 10(3):522-525.
[63]Everitt DE, Soumerai SB, Avorn J, et al. Changing surgical antimicrobial prophylaxis practices through education targeted at senior department leaders[J]. Infect Control Hosp Epidemiol.1990; 11(11):578-583.
[64]McGowan JE, Jr., Finland M. Usage of antibiotics in a general hospital: effect of requiring justification[J]. J Infect Dis.1974; 130(2):165-168.
[65]Craig WA, Uman SJ, Shaw WR, et al. Hospital use of antimicrobial drugs. Survey at 19 hospitals and results of antimicrobial control program[J]. Ann Intern Med.1978; 89(5 Pt 2 Suppl):793-795.
[66]White AC, Jr., Atmar RL, Wilson J, et al. Effects of requiring prior authorization for selected antimicrobials:expenditures, susceptibilities, and clinical outcomes[J]. Clin Infect Dis.1997; 25(2):230-239.
[67]Cannon JP, Silverman RM. A pharmacist-driven antimicrobial approval program at a Veterans Affairs hospital [J]. Am J Health Syst Pharm.2003; 60(13):1358-1362.
[68]Woodward RS, Medoff G, Smith MD, et al. Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital[J]. Am J Med.1987; 83(5):817-823.
[69]Rahal JJ, Urban C, Horn D, et al. Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella[J]. JAMA. 1998; 280(14):1233-1237.
[70]Allegranzi B, Luzzati R, Luzzani A, et al. Impact of antibiotic changes in empirical therapy on antimicrobial resistance in intensive care unit-acquired infections [J].J Hosp Infect.2002; 52(2):136-140.
[71]Burke JP. Antibiotic resistance-squeezing the balloon[J]? JAMA.1998; 280(14):1270-1271.
[72]Piroth L, Aube H, Doise JM, et al. Spread of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae:are beta-lactamase inhibitors of therapeutic value[J]? Clin Infect Dis.1998; 27(1):76-80.
[73]Landman D, Chockalingam M, Quale JM. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidimeresistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary[J]. Clin Infect Dis.1999; 28(5):1062-1066.
[74]Lan CK, Hsueh PR, Wong WW, et al. Association of antibiotic utilization measures and reduced incidence of infections with extended-spectrum betalactamase-producing organisms[J]. J Microbiol Immunol Infect.2003; 36(3):182-186.
[75]Rice LB, Eckstein EC, DeVente J, et al. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center[J]. Clin Infect Dis.1996; 23(1):118-124.
[76]Quale J, Landman D, Saurina G, et al. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci[J]. Clin Infect Dis.1996; 23(5):1020-1025.
[77]O'Connor KA, Kingston M, O'Donovan M, et al. Antibiotic prescribing policy and Clostridium difficile diarrhoea[J]. QJM.2004; 97(7):423-429.
[78]Wilcox MH, Freeman J, Fawley W, et al. Long-term surveillance of cefotaxime and piperacillin-tazobactam prescribing and incidence of Clostridium difficile diarrhoea[J]. J Antimicrob Chemother.2004; 54(1): 168-172.
[79]Lautenbach E, LaRosa LA, Marr AM, et al. Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions:impact of progressive restrictions on use of vancomycin and third-generation cephalosporins[J]. Clin Infect Dis.2003; 36(4):440-446.
[80]Fraser GL, Stogsdill P, Dickens JD, Jr., et al. Antibiotic optimization. An evaluation of patient safety and economic outcomes [J]. Arch Intern Med. 1997; 157(15):1689-1694.
[81]Gums JG, Yancey RW, Jr., Hamilton CA, et al. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team [J]. Pharmacotherapy 1999; 19(12):1369-77.
[82]Solomon DH, van Houten L, Glynn RJ, et al. Academic detailing to improve use of broadspectrum antibiotics at an academic medical center[J]. Arch Intern Med.2001; 161(15):1897-1902.
[83]Carling P, Fung T, Killion A, et al. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years [J]. Infect Control Hosp Epidemiol.2003; 24(9):699-706.
[84]Feucht CL, Rice LB. An interventional program to improve antibiotic use[J]. Ann Pharmacother.2003; 37(5):646-651.
[85]Cook PP, Catrou PG, Christie JD, et al. Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram[J]. J Antimicrob Chemother.2004; 53(5):853-859.
[86]Bantar C, Sartori B, Vesco E, et al. A hospitalwide intervention program to optimize the quality of antibiotic use:impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance[J]. Clin Infect Dis.2003; 37(2):180-186.
[87]Gentry CA, Greenfield RA, Slater LN, et al. Outcomes of an antimicrobial control program in a teaching hospital[J]. Am J Health Syst Pharm.2000; 57(3):268-274.
[88]Luna, CM, Vujacich P, Niederman MS, et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia[J]. Chest.1997; 111(3):676-685.
[89]Leibovici L, Shraga I, Drucker M, et al. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection[J]. J Intern Med.1998; 244(5):379-386.
[90]Kollef MH, Sherman G, Ward S, et al. Inadequate antimicrobial treatment of infections:a risk factor for hospital mortality among critically ill patients[J]. Chest.1999; 115(2):462-474.
[91]Ibrahim EH, G. Sherman, S. Ward, V. J. Fraser, and M. H. Kollef. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting[J]. Chest.2000; 118(1):146-155.
[92]Lodise TP, McKinnon PS, Swiderski L, et al. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia[J]. Clin Infect Dis.2003; 36(11):1418-1423.
[93]Mac Arthur, RD, Miller M, Albertson T, et al. Adequacy of early empiric antibiotic treatment and survival in severe sepsis:experience from the MONARCS trial[J]. Clin Infect Dis.2004; 38(2):284-288.
[94]Kollef MH. Inadequate antimicrobial treatment:an important determinant of outcome for hospitalized patients[J]. Clin Infect Dis.2000; 31 (Suppl 4): S131-138.
[95]American Thoracic Society/Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilatorassociated, and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med.2005; 171(4):388-416.
[96]Paterson DL, Rice LB. Empirical antibiotic choice for the seriously ill patient:are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive[J]? Clin Infect Dis. 1997; 25(5):1006-1012.
[97]Schentag JJ, Ballow CH, Fritz AL, et al. Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious disease division, and the microbiology laboratory[J]. Diagn Microbiol Infect Dis.1993; 16(3):255-264.
[98]Micek ST, Ward S, Fraser VJ, et al. A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia[J]. Chest.2004; 125(5):1791-1799.
[99]Shojania KG, Yokoe D, Platt R, et al. Reducing vancomycin use utilizing a computer guideline:results of a randomized controlled trial[J]. J Am Med Inform Assoc.1998; 5(6):554-562.
[100]Richards MJ, Robertson MB, Dartnell JG, et al. Impact of a web-based antimicrobial approval system on broadspectrum cephalosporin use at a teaching hospital[J]. Med J Aust.2003; 178(8):386-390.
[101]Calfee DP, Brooks J, Zirk NM, et al. A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme[J]. J Hosp Infect.2003; 55(1):26-32.
[102]Glowacki RC, Schwartz DN, Itokazu GS, et al. Antibiotic combinations with redundant antimicrobial spectra:clinical epidemiology and pilot intervention of computer-assisted surveillance[J]. Clin Infect Dis.2003; 37(1):59-64.
[103]Evans RS, Classen DC, Pestotnik SL, et al. Improving empiric antibiotic selection using computer decision support[J]. Arch Intern Med.1994; 154(8):878-884.
[104]Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents [J]. N Engl J Med.1998; 338(4):232-8.
[105]Pestotnik SL, Classen DC, Evans RS, et al. Implementing antibiotic practice guidelines through computer-assisted decision support:clinical and financial outcomes[J]. Ann Intern Med.1996; 124(10):884-90.
[106]Gerding DN. Antimicrobial cycling:lessons learned from the aminoglycoside experience[J]. Infect Control Hosp Epidemiol.2000; 21(1 Suppl):S12-17.
[107]Francetic I, Kalenic S, Huic M, et al. Impact of Aminoglycoside Cycling in Six Tertiary Intensive Care Units:Prospective Longitudinal Interventional Study [J]. Croat Med J.2008; 49(2):207-214.
[108]John JF Jr. Antibiotic cycling:is it ready for prime time[J]? Infect Control Hosp Epidemiol.2000; 21(1):9-11.
[109]Hodges BM, White RL. Antimicrobial cycling:the future or a fad[J]? Ann Pharmacother.2001; 35(10):1224-1232.
[110]Kollef MH. Is there a role for antibiotic cycling in the intensive care unit[J]? Crit Care Med.2001; 29(4 Suppl):N135-142.
[111]Pujol M, Gudiol F. Evidence for antibiotic cycling in control of resistance[J]. Curr Opin Infect Dis.2001; 14(6):711-715.
[112]Fridkin SK. Routine cycling of antimicrobial agents as an infection control measure[J]. Clin Infect Dis.2003; 36(11):1438-1444.
[113]Masterson RG. Antibiotic cycling:more than it might seem[J]? J Antimicrob Chemother.2005; 55(1):1-5.
[114]Brown EM, Nathwani D. Antibiotic cycling or rotation:a systematic review of the evidence of efficacy [J]. J Antimicrob Chemother.2005; 55(1):6-9.
[115]Merz LR, Warren DK, Kollef MH, et al. Effects of an antibiotic cycling program on antibiotic prescribing practices in an intensive care unit[J]. Antimicrob Agents Chemother.2004; 48(8):2861-2865.
[116]Bonhoeffer S, Lipsitch M, Levin BR. Evaluating treatment protocols to prevent antibiotic resistance[J].1997; 94(22):12106-12111.
[117]Bergstrom CT, Lo M, Lipsitch M. Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals[J].2004; 101(36):13285-90.
[118]Lipsitch M, Levin BR. The population dynamics of antimicrobial chemotherapy [J]. Antimicrob. Agents Chemother.1997; 41(2):363-673.
[119]Austin DJ, Kristinsson KG, Anderson RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance[J]. Proc Natl Acad Sci USA.1999; 96(3): 1152-1156.
[120]Monnet DL, Archibald LK, Phillips L, et al. Antimicrobial use and resistance in eight US hospitals:complexities of analysis and modeling. Intensive Care Antimicrobial Resistance Epidemiology Project and National Nosocomial Infections Surveillance System Hospitals[J]. Infect Control Hosp Epidemiol.1998; 19(6):388-394.
[121]Crowcroft NS, Ronveaux O, Monnet DL, et al. Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals[J]. Infect Control Hosp Epidemiol.1999; 20(1):31-36.
[122]Fridkin SK, Steward CD, Edwards JR, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals:project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals[J]. Clin Infect Dis.1999; 29(2):245-252.
[123]Fridkin SK, Edwards JR, Courval JM, et al. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units[J]. Ann Intern Med.2001; 135(3):175-183.
[124]Zervos MJ, Hershberger E, Nicolau DP, et al. Relationship between fluoroquinolone use and changes in susceptibility to fluoroquinolones of selected pathogens in 10 United States teaching hospitals,1991-2000[J]. Clin Infect Dis.2003; 37(12):1643-1648.
[125]Bhavnani SM, Hammel JP, Jones RN, et al. Relationship between increased levofloxacin use and decreased susceptibility of Streptococcus pneumoniae in the United States[J]. Diagn Microbiol Infect Dis.2005; 51(1):31-37.
[126]Lopez-Lozano JM, Monnet DL, Yague A, et al. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use:a time series analysis[J]. Int J Antimicrob Agents.2000; 14(1):21-31.
[127]Monnet DL, Lopez-Lozan o JM, Campillos P, et al. Making sense of antimicrobial use and resistance surveillance data:application of ARIMA and transfer function models[J]. Clin Microbiol Infect.2001; 7 (Suppl 5): 29-36.
[128]Monnet DL, MacKenzie FM, Lopez-Lozano JM, et al. Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000[J]. Emerg Infect Dis.2004; 10(8):1432-1441.
[129]Loeb, M. Antibiotic use in long-term-care facilities:many unanswered questions[J]. Infect Control Hosp Epidemiol.2000; 21(10):680-683.
[130]Capitano B, Nicolau DP. Evolving epidemiology and cost of resistance to antimicrobial agents in long-term care facilities[J]. J Am Med Dir Assoc. 2003; 4(3 Suppl):S90-99..
[131]Viray M, Linkin D, Maslow JN, et al. Longitudinal trends in antimicrobial susceptibilities across long-term-care facilities:emergence of fluoroquinolone resi stance [J]. Infect Control Hosp Epidemiol.2005; 26(1): 56-62.
[132]Chin T. Doctors pull plug on paperless system[N]. Am Med News.2003; 46:5-8.
[133]Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes:a systematic review[J]. JAMA.2005;293(10):1223-1238.
[134]Madaras-Kelly K. Optimizing antibiotic use in hospitals:the role of population-based antibiotic surveillance in limiting antibiotic resistance Insights from the society of infectious diseases pharmacists[J]. Pharmacotherapy.2003; 23(12):1627-1633.
[135]Bhavnani SM. Benchmarking in health-system pharmacy:current research and practical applications [J]. Am J Health Syst Pharm.2000; 57 (Suppl 2): S13-20.