Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis.
Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis.
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DOI：
10.1136/bmj.i939
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发表时间：
2016-03-15
期刊：
影响因子：
--
通讯作者：
Costelloe C
中科院分区：
文献类型：
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作者：
Bryce A;Hay AD;Lane IF;Thornton HV;Wootton M;Costelloe C
目标 系统回顾调查儿童大肠杆菌引起的尿路感染抗生素耐药性流行情况的研究，并在适当时对初级保健中先前使用的抗生素与耐药性之间的关系进行荟萃分析。设计和数据分析系统审查和荟萃分析。初级保健儿童对最常用抗生素耐药率的汇总百分比，按研究国家的 OECD（经济合作与发展组织）地位进行分层。随机效应荟萃分析用于量化先前在初级保健中接触抗生素与耐药性之间的关联。数据来源 通过 Medline、Embase、Cochrane 和 ISI Web of Knowledge 数据库确定的观察性和实验性研究，检索了截至 2015 年 10 月发表的文章。 选择研究的资格标准 如果研究调查并报告了 0-17 岁儿童和青少年社区获得性尿路感染的耐药性，则研究符合资格。使用 MeSH 术语和文本单词进行电子搜索，识别出 3115 篇论文。两名独立评审员评估研究质量并进行数据提取。结果 58 项观察性研究调查了尿液中的 77 783 株大肠杆菌分离株。在 OECD 国家的研究中，氨苄青霉素的汇总耐药率为 53.4%（95% 置信区间为 46.0% 至 60.8%），甲氧苄啶为 23.6%（13.9% 至 32.3%），考阿莫昔拉为 8.2%（7.9% 至 9.6%），阿莫西林为 2.1%（0.8 至 4.4%）。环丙沙星；呋喃妥因最低，为 1.3%（0.8% 至 1.7%）。经合组织国家以外国家的研究显示，耐药性明显较高：氨苄西林为 79.8%（73.0% 至 87.7%），阿莫昔拉为 60.3%（40.9% 至 79.0%），环丙沙星为 26.8%（11.1% 至 43.0%），环丙沙星为 17.0%（9.8% 至 24.2%）。呋喃妥因。有证据表明，从先前在初级保健中接受过抗生素处方的个别儿童的尿道中分离出的细菌更有可能对抗生素产生耐药性，并且这种增加的风险可能持续长达六个月（比值比 13.23，95% 置信区间 7.84 至 22.31）。结论 在初级保健中，大肠杆菌引起的尿路感染儿童对常用处方抗生素的耐药率很高，特别是在经合组织以外的国家，其中一种可能的解释是可以在柜台购买抗生素。这可能会使一些抗生素作为尿路感染的一线治疗无效。在初级保健中常规使用抗生素会导致儿童对抗生素产生耐药性，这种耐药性可能会在治疗后持续长达六个月。
Objectives To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance. Design and data analysis Systematic review and meta-analysis. Pooled percentage prevalence of resistance to the most commonly used antibiotics in children in primary care, stratified by the OECD (Organisation for Economic Co-operation and Development) status of the study country. Random effects meta-analysis was used to quantify the association between previous exposure to antibiotics in primary care and resistance. Data sources Observational and experimental studies identified through Medline, Embase, Cochrane, and ISI Web of Knowledge databases, searched for articles published up to October 2015. Eligibility criteria for selecting studies Studies were eligible if they investigated and reported resistance in community acquired urinary tract infection in children and young people aged 0-17. Electronic searches with MeSH terms and text words identified 3115 papers. Two independent reviewers assessed study quality and performed data extraction. Results 58 observational studies investigated 77 783 E coli isolates in urine. In studies from OECD countries, the pooled prevalence of resistance was 53.4% (95% confidence interval 46.0% to 60.8%) for ampicillin, 23.6% (13.9% to 32.3%) for trimethoprim, 8.2% (7.9% to 9.6%) for co-amoxiclav, and 2.1% (0.8 to 4.4%) for ciprofloxacin; nitrofurantoin was the lowest at 1.3% (0.8% to 1.7%). Resistance in studies in countries outside the OECD was significantly higher: 79.8% (73.0% to 87.7%) for ampicillin, 60.3% (40.9% to 79.0%) for co-amoxiclav, 26.8% (11.1% to 43.0%) for ciprofloxacin, and 17.0% (9.8% to 24.2%) for nitrofurantoin. There was evidence that bacterial isolates from the urinary tract from individual children who had received previous prescriptions for antibiotics in primary care were more likely to be resistant to antibiotics, and this increased risk could persist for up to six months (odds ratio 13.23, 95% confidence interval 7.84 to 22.31). Conclusions Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment.