抗生素的消耗量与金葡和铜绿耐药率之间的关系：来自法国47家医院的报告

David

Infect Control Hosp Epidemiol 2007;28:1389-1395

ORIGINAL ARTICLE

Relationship Between Rates of Antimicrobial Consumption and the Incidence of Antimicrobial Resistance in Staphylococcus aureus and Pseudomonas aeruginosa Isolates From 47 French Hospitals
抗生素的消耗量与金葡和铜绿耐药率之间的关系：来自法国47家医院的报告
A. M. Rogues, MD, PhD; C. Dumartin, DPharm; B. Amadéo; A. G. Venier, MD; N. Marty, MD, PhD; P. Parneix, MD; J. P. Gachie, MD, MPH

From the Unité INSERM 657—Pharmacoépidémiologie et évaluation de l'impact des produits de santé sur les populations, IFR Santé Publique Université Victor Ségalen (A.-M.R., J.P.G.), the Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, CHU Groupe hospitalier Pellegrin (C.D., B.A., A.G.V., P.P.), the Service d'Hygiène Hospitalière, CHU Groupe hospitalier Pellegrin, Bordeaux (A.M.R., J.P.G.), the Service de Microbiologie, Hôpital Purpan, Toulouse (N.M.), France.

Address reprint requests to Anne-Marie Rogues, MD, PhD, Unité INSERM 657, Université Bordeaux 2, France (marie.rogues@chu-bordeaux.fr[/email]).

Received April 17, 2007; accepted August 3, 2007; electronically published November 1, 2007.


OBJECTIVE.     To investigate relationships between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from hospitals.

METHODS.     We conducted an observational study that used retrospective data from 2002 and linear regression to model relationships. Hospitals were asked to collect data on consecutive S. aureus and P. aeruginosa isolates, consumption rates for antibiotics (ie, anti-infectives for systemic use as defined by Anatomical Therapeutic Chemical class J01), and hospital characteristics, including infection control policies. Rates of methicillin resistance in S. aureus and rates of ceftazidime and ciprofloxacin resistance in P. aeruginosa were expressed as the percentage of isolates that were nonsusceptible (ie, either resistant or intermediately susceptible) and as the incidence of nonsuceptible isolates (ie, the number of nonsuceptible isolates recovered per 1,000 patient-days). The rate of antimicrobial consumption was expressed as the number of defined daily doses per 1,000 patient-days.

SETTING.     Data were obtained from 47 French hospitals, and a total of 12,188 S. aureus isolates and 6,370 P. aeruginosa isolates were tested.

RESULTS.     In the multivariate analysis, fewer antimicrobials showed a significant association between the consumption rate and the percentage of isolates that were resistant than an association between the consumption rate and the incidence of resistance. The overall rate of antibiotic consumption, not including the antibiotics used to treat methicillin-resistant S. aureus infection, explained 13% of the variance between hospitals in the incidence of methicillin resistance among S. aureus isolates. The incidence of methicillin resistance in S. aureus isolates increased with the use of ciprofloxacin and levofloxacin and with the percentage of the hospital's beds located in intensive care units (adjusted multivariate coefficient of determination [aR2], 0.30). For P. aeruginosa, the incidence of ceftazidime resistance was greater in hospitals with higher consumption rates for ceftazidime, levofloxacin, and gentamicin (aR2, 0.37). The incidence of ciprofloxacin resistance increased with the use of fluoroquinolones and with the percentage of a hospital's beds located in intensive care ( aR2, 0.28).

CONCLUSIONS.     A statistically significant relationship existed between the rate of fluoroquinolone use and the rate of antimicrobial resistance among S. aureus and P. aeruginosa isolates. The incidence of resistant isolates showed a stronger association with the rate of antimicrobial use than did the percentage of isolates with resistance.

[ 本帖最后由 David 于 2007-11-15 16:53 编辑 ]

缭绕

一篇很好的文章，很有说服力，比空洞地说要合理用药来得好！哪位高手翻啊？一定加高分！:lol

右手心

论
氟喹诺酮的使用率与抗生素对金黄色葡萄球菌和铜绿耐药之间关系有统计学意义.
抗生素的使用率与耐药发生之间存在很强的关联性

胡杨

菌药物使用率与金葡和铜绿耐药菌发生率之间的关系：来自法国47家医院的报告
杂志名称与发表时间：感染控制医院流行病学Infect Control Hosp Epidemiol 2007;28:1389-1395
作者：（略）
作者单位与机构名称：（略）
受理与发表日期：（略）
目的：调查抗菌药物使用率与医院金葡和铜绿耐药菌发生率之间的关系。
方法：对2002年资料进行回顾研究，对模型相关性做线性回归。统计抗生素使用率（J01级抗感染化疗用药为准）；医院感控政策；检出MRSA和耐头孢他啶/环丙沙星绿脓杆菌（耐药与中介）的百分比。耐药发生率以每日每1000病人中分离到的不敏感菌（耐药与中介）数量计。抗菌药物使用率以每日每1000病人限定日剂量（DDD）的数量计。
背景资料：数据来自于法国47家医院，合计共检出12188株金黄色葡萄球菌和6370株绿脓杆菌。
结果：经多元分析显示，抗菌药物使用率与耐药发生率有关。但抗菌药物使用率与耐药菌检出百分比显著相关的药物极少。不包括治疗MRSA感染的抗菌药物在内，敏感金葡菌转耐药的抗菌药物总使用率，被调查医院间有13%的差异。敏感金葡菌转耐药的发生，与环丙沙星和左氧氟沙星的使用和医院ICU床位百分比相关（校正多元决定系数AR2=0.3）。医院头孢他啶，左氧氟沙星，庆大霉素的高使用率，导致绿脓杆菌的头孢他啶耐药更多（AR2=0.37）。环丙沙星耐药菌的产生，与使用氟喹诺酮类药物和医院ICU床位百分比相关（AR2=0.28）。
结论：氟喹诺酮的使用率和金葡菌、绿脓杆菌的耐药，在统计学上显著相关。检出菌的耐药性的变化与耐药菌株百分比两者之间，抗菌药物的使用对前者影响更大。

David

译了这么多国外的文献，多么希望在某个SCI杂志上发现一篇中国人写的院感的文章，老外的方法其实也不咋的阿。:Q