Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals
Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals
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DOI：
10.1086/432056
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发表时间：
2005-08-15
影响因子：
11.8
通讯作者：
Polk, RE
中科院分区：
文献类型：
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作者：
MacDougall, C;Powell, JP;Polk, RE
背景氟喹诺酮类药物在医院和社区被广泛使用。先前的研究表明氟喹诺酮类药物的使用与耐氟喹诺酮类药物的大肠埃希氏菌和耐甲氧西林金黄色葡萄球菌（MRSA）的分离之间存在关联。我们进行了一项生态学水平的研究，以确定医院氟喹诺酮耐药大肠埃希菌的百分比是否存在差异。大肠杆菌和MRSA与医院及其周围社区氟喹诺酮类药物的使用有关。我们测量了2000年美国17家医院及其周边社区的氟喹诺酮类药物使用情况。医院氟喹诺酮类药物使用的数据是从账单数据中提取的。社区使用氟喹诺酮类药物的数据来自IMS健康数据，这些数据来自每家医院16公里半径范围内药房的所有处方。我们使用医院的细菌学图谱来确定耐氟喹诺酮类大肠埃希菌的分离株的百分比。结果：1999年，我院分离的耐药大肠埃希菌和耐甲氧西林金黄色葡萄球菌中，耐药菌株的比例与医院及周边社区氟喹诺酮类药物的使用情况呈线性回归关系。医院内氟喹诺酮类药物的总使用量与沙门氏菌感染率之间存在显著相关性。金黄色葡萄球菌分离株中MRSA（r = 0.77; P= 0.0003）和社区总氟喹诺酮使用（r = 0.77 P = 0.0003）与E.大肠埃希菌分离株对氟喹诺酮类药物耐药。16公里半径范围内的人口密度也与MRSA百分比（r = 0.57; P = 0.015）和氟喹诺酮类Pp. 015抗性E.大肠杆菌百分比（r = 0.85; P = 0.002），但调整人口密度后，氟喹诺酮类药物总使用量与耐药性之间的相关性（r= 0.85 P = 0.002）仍然显著。在这个生态学分析中，我们发现医院氟喹诺酮类药物的使用与沙门氏菌甲氧西林耐药性之间存在关联。社区氟喹诺酮类药物使用与大肠埃希菌耐药之间的关系。医院里的大肠杆菌。医院和社区的抗菌药物使用对于医院中遇到的不同病原体的耐药性可能具有不同的相对重要性。
Background. Fluoroquinolones are widely prescribed in hospitals and the community. Previous studies have shown associations between fluoroquinolone use and isolation of fluoroquinolone-resistant Eshcerichia coli and methicillin-resistant Staphylococcus aureus (MRSA). We performed an ecologic-level study to determine whether variability in hospital percentages of fluoroquinolone-resistant E. coli and MRSA were associated with fluoroquinolone use in hospitals and their surrounding communities.Methods. We measured fluoroquinolone use in 17 US hospitals and their surrounding communities in the year 2000. Data on fluoroquinolone use in hospitals was electronically extracted from billing data. Data on fluoroquinolone use in communities was obtained from IMS health data for all prescriptions filled in pharmacies within a 16-km radius of each hospital. We used hospital antibiograms to determine the percentage of isolates that were fluoroquinolone-resistant E. coli and MRSA, and we performed linear regression to determine the relationship between percentage of resistant isolates and fluoroquinolone use in hospitals and their surrounding communities.Results. There was a significant association between total fluoroquinolone use within hospitals and percentage of S. aureus isolates that were MRSA (r = 0.77; P=.0003) and between total fluoroquinolone use in the community (r = 0.77 P = 0003) and percentage of E. coli isolates that were fluoroquinolone-resistant E. coli (r = 0.68; P = .003) Population density within the 16-km radius also correlated with MRSA percentage ( r= 0.57; P = .015) and fluoroquinolonerp Pp. 015 resistant E. coli percentage (r = 0.85; P =.002) but associations between total fluoroquinolone use and resistance (r= 0.85 P = .002) remained significant after adjustment for population density.Conclusions. In this ecologic analysis, we found associations between fluoroquinolone use in hospitals and methicillin resistance in S. aureus and between fluoroquinolone use in communities and fluoroquinolone resistance in E. coli in hospitals. Antimicrobial use in hospitals and communities may have different relative importance with regard to resistance in different pathogens encountered in hospitals.