The relationship between primary care antibiotic prescribing and bacterial resistance in adults in the community: a controlled observational study using individual patient data
The relationship between primary care antibiotic prescribing and bacterial resistance in adults in the community: a controlled observational study using individual patient data
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DOI：
10.1093/jac/dki181
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发表时间：
2005-07-01
影响因子：
5.2
通讯作者：
MacGowan, A
中科院分区：
文献类型：
--
作者：
Hay, AD;Thomas, M;MacGowan, A
目的：研究初级保健处方抗生素与会阴菌群中抗生素耐药性发展之间的关系，这些菌群污染来自代表一般社区的大量无症状成年人样本中的未选择的尿液分离株。患者和方法：污染尿液样本的大肠杆菌分离株是从前雅芳和格洛斯特郡卫生当局地区在全科诊所注册的年龄 > 16 岁的无症状成年人中获得的。从初级保健电子和纸质病历中收集了提供尿液样本前 12 个月内抗生素暴露的数据。主要结果指标是对阿莫西林或甲氧苄啶或两者的耐药性。结果：2943 名成年人提交了尿液样本。大肠杆菌分离株的敏感性和抗生素处方数据来自 618 名患者。我们没有发现任何证据表明耐药性与患者在过去 12 个月内接触初级保健中处方的任何抗生素之间存在关联 [调整后的比值比 (OR) 1.12，95% 置信区间 0.77-1.65，P = 0.52]。二次分析表明，2 个月内接触抗生素的患者具有更大的耐药性（调整后 OR 1.95, 1.08-3.49，P = 0.03），与过去 12 个月内增加甲氧苄啶暴露量存在剂量反应关系（调整后 OR 1.01, 1.01-1.02，P = 0.001），以及过去 12 个月内服用过任何 β-内酰胺抗生素的个体阿莫西林 MIC 是未服用任何 β-内酰胺类药物的患者的两倍以上（调整后的 95% CI 1.23-3.31，P = 0.009）。结论：成人在 12 个月期间是否接受任何抗生素处方似乎不会影响会阴菌群的抗菌药物耐药性。然而，发现的时间和剂量反应关系可能暗示因果关系，应该成为进一步研究的重点。
Objectives: To examine the relationship between primary care prescribed antibiotics and the development of antibiotic resistance in perineal flora contaminating unselected urinary isolates from a large sample of asymptomatic adults representative of the general community.Patients and methods: Escherichia coli isolates contaminating urine samples were obtained from asymptomatic adults aged > 16 years registered with general practices in the former Avon and Gloucestershire health authority areas. Data on antibiotic exposure during the 12 months prior to providing the urine samples were collected from the primary care electronic and paper medical records. The main outcome measure was resistance to amoxicillin or trimethoprim or both.Results: Two thousand nine hundred and forty-three adults submitted urine samples. Susceptibility among E. coli isolates and antibiotic prescribing data were available from 618 patients. We found no evidence of an association between resistance and patients' exposure to any antibiotic prescribed in primary care in the previous 12 months [adjusted odds ratio (OR) 1.12, 95% confidence interval 0.77-1.65, P = 0.52]. Secondary analyses demonstrated greater resistance in patients exposed to antibiotics within 2 months (adjusted OR 1.95, 1.08-3.49, P = 0.03), a dose-response relationship to increasing exposure to trimethoprim in the previous 12 months (adjusted OR 1.01, 1.01-1.02, P = 0.001) and that individuals who had been prescribed any beta-lactam antibiotic in the previous 12 months had amoxicillin MICs more than twice (adjusted 95% CI 1.23-3.31, P = 0.009) that of those who had not been prescribed any beta-lactams.Conclusions: Whether or not adults receive a prescription for any antibiotic during a 12 month period does not appear to influence the antimicrobial resistance of perineal flora. However, the temporal and dose-response relationships found may be suggestive of a causative association and should be the focus of further research.