Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community
Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community
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DOI：
10.1093/jac/dkq525
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发表时间：
2011-04-01
影响因子：
5.2
通讯作者：
Harbarth, Stephan
中科院分区：
文献类型：
--
作者：
Vernaz, Nathalie;Huttner, Benedikt;Harbarth, Stephan
目的：确定抗生素使用和耐药大肠杆菌的发病率之间的时间关系在住院和门诊设置的一个大urbanarea.Methods：进行回顾性观察时间序列分析，以评估非重复临床分离株的大肠杆菌的发病率。结果：2000年1月至2007年12月，大肠埃希菌对环丙沙星、甲氧苄啶/磺胺甲恶唑和头孢吡肟耐药率从2000年的6.0%上升到15.4头孢吡肟耐药率从2002年的0.9%上升到2007年的3.2%（P = 0.01）。甲氧苄啶/磺胺甲恶唑耐药率保持稳定（23.7%~ 25.8%）。在这两种情况下，抗生素的总使用量都有所增加，而氟喹诺酮类药物的使用仅在门诊患者中显著增加。社区大肠埃希氏菌对氟喹诺酮类药物耐药的时间效应。大肠杆菌分离株和门诊使用环丙沙星（立即生效和时间滞后1个月）和氟沙星（时间滞后4个月），解释51%的变化随着时间的推移。头孢吡肟耐药的发生率在大肠埃希菌。大肠埃希菌感染与住院患者（滞后1个月）和门诊患者（滞后4个月）使用环丙沙星有关，与医院使用头孢曲松（滞后0个月）、哌拉西林/他唑巴坦（3个月）和头孢吡肟（3个月）有关（R-2 = 51%）。大肠杆菌包括超广谱β-内酰胺酶生产者，并显示时间序列分析的附加值，以更好地了解社区和医院抗生素处方之间的相互作用及其对抗生素耐药性的溢出效应。
Objectives: To determine the temporal relationship between antibiotic use and incidence of antibiotic-resistant Escherichia coli in both the inpatient and outpatient setting of a large urban area.Methods: A retrospective observational time-series analysis was performed to evaluate the incidence of non-duplicate clinical isolates of E. coli resistant to ciprofloxacin, trimethoprim/sulfamethoxazole and cefepime from January 2000 through December 2007, combined with a transfer function model of aggregated data on antibiotic use in both settings obtained from the hospital's pharmacy and outpatient billing offices.Results: Ciprofloxacin resistance increased from 6.0% (2000) to 15.4% (2007; P < 0.0001) and cefepime resistance from 0.9% (2002) to 3.2% (2007; P = 0.01). Trimethoprim/sulfamethoxazole resistance remained stable (23.7%-25.8%). Total antibiotic use increased in both settings, while fluoroquinolone use increased significantly only among outpatients. A temporal effect between fluoroquinolone resistance in community E. coli isolates and outpatient use of ciprofloxacin (immediate effect and time lag 1 month) and moxifloxacin (time lag 4 months) was observed, explaining 51% of the variance over time. The incidence of cefepime resistance in E. coli was correlated with ciprofloxacin use in the inpatient (lag 1 month) and outpatient (lag 4 months) settings and with the use of ceftriaxone (lag 0 month), piperacillin/tazobactam (3 months) and cefepime (3 months) in the hospital (R-2 = 51%).Conclusions: These results support efforts to reduce prescribing of fluoroquinolones for control of resistant E. coli including extended-spectrum beta-lactamase producers and show the added value of time-series analysis to better understand the interaction between community and hospital antibiotic prescribing and its spill-over effect on antibiotic resistance.