发展中国家抗生素使用导致金葡菌和大肠杆菌耐药

潮水

Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region
American Journal of Infection Control
Volume 38, Issue 3, Pages 212-216 (April 2010)
Background
This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions.

Methods
MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions.

Results
Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P=.04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P=.002), combination penicillins (P=.018), and aminoglycosides (P=.014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P=.005), but a negative association was evident for beta-lactamase–resistant penicillins (P=.010) and first-generation cephalosporins (P=.012).

Conclusions
The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations.

Key Words: Antibiotic, correlation, regression, Mediterranean, developing country, resistance

天师

发展中国家抗生素使用导致金葡菌和大肠杆菌耐药
美国感染控制杂志，2010，38（3）212~216

【背景】为了研究在地中海的南部和东部医疗机构中耐甲氧西林金黄色葡萄球菌（MRSA）和耐三代头孢大肠杆菌（3GCREC）的耐药因素提供线索。
【方法】来自19个地区医院的MRSA和3GCREC敏感度与抗菌药物使用量相关研究方法，ARMed项目已经发表。
【结果】报告MRSA中低检出率的医院抗菌药物总使用量较低，差异有显著性。MRSA所占比例随着碳青霉烯类使用量提高而提高（P=0.04)。多因素分析显示，碳青霉烯类使用与青霉素类和氨基糖甙类抗菌药物均具有正相关性（P分别为0.018、0.014）。耐三代头孢大肠杆菌比例与抗菌药物使用量未发现差异。多元线性回归分析显示，耐三代头孢大肠杆菌与抗生素使用量正相关，然而耐Blac青霉素和一代头孢与抗生素使用量负相关。
【结论】研究结果表明耐药性与抗菌药物使用相关，特别是碳青霉烯类和第三代头孢菌素。这些数据表明：在发展中国家医院尽快要执行抗菌药物管理和使用，而不是大量习惯性使用广谱抗菌药物。
[关键词]抗菌药物；相关；回归；地中海；发展中国家；耐药性