Determinants of between-country differences in ambulatory antibiotic use and antibiotic resistance in Europe: a longitudinal observational study
Determinants of between-country differences in ambulatory antibiotic use and antibiotic resistance in Europe: a longitudinal observational study
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DOI：
10.1093/jac/dkt377
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发表时间：
2014-02-01
影响因子：
5.2
通讯作者：
Beutels, P.
中科院分区：
文献类型：
--
作者：
Blommaert, A.;Marais, C.;Beutels, P.
为了确定解释抗生素使用和耐药性的国家年变化的关键决定因素，收集了1999年至2007年19个欧洲国家的门诊抗生素使用数据[每1000名居民每天的定义日剂量（DID）]，沿着181个变量，这些变量描述了各国的农业、文化、人口、疾病负担、教育、医疗保健组织和社会经济学。在评估了数据的可用性、重叠性和相关性后，采用多插补广义估计方程和逐步选择程序来选择全球抗生素使用的重要决定因素（以DID表示），亚组的相对使用（阿莫西林和复方阿莫西林）和大肠杆菌和肺炎链球菌的耐药性。相对湿度，医疗保健支出与国内生产总值成比例，不信任感，年龄在65岁的人群比例和治疗指南的可用性与以DID表示的较高的抗生素总使用量相关。对处方者的营销活动限制、人口密度、抗生素数量、教育程度和无神论程度与使用的DID总数较低相关。阿莫西林和复方阿莫西林的相对处方主要取决于医疗保健系统的选择[例如，全科医生（GP）注册和限制上市]。发现特定抗生素的使用是某些但不是所有药物/微生物组合的耐药性的重要决定因素。鼓励全科医生把关的激励措施与较低水平的耐药性相关，65岁时的预期寿命和无神论与更多的耐药性相关。在国家一级，有无数因素影响抗生素的使用和耐药性，其中一个重要部分可以通过政策选择进行修改。
To identify key determinants explaining countryyear variations in antibiotic use and resistance.Ambulatory antibiotic use data [in defined daily doses per 1000 inhabitants per day (DIDs)] for 19 European countries from 1999 to 2007 were collected, along with 181 variables describing countries in terms of their agriculture, culture, demography, disease burden, education, healthcare organization and socioeconomics. After assessing data availability, overlap and relevance, multiple imputation generalized estimating equations were applied with a stepwise selection procedure to select significant determinants of global antibiotic use (expressed in DIDs), relative use of subgroups (amoxicillin and co-amoxiclav) and resistance of Escherichia coli and Streptococcus pneumoniae.Relative humidity, healthcare expenditure proportional to gross domestic product, feelings of distrust, proportion of population aged 65 years and availability of treatment guidelines were associated with higher total antibiotic use expressed in DIDs. Restrictions on marketing activities towards prescribers, population density, number of antibiotics, educational attainment and degree of atheism were associated with a lower number of total DIDs used. Relative prescribing of amoxicillin and co-amoxiclav was mainly determined by healthcare system choices [e.g. general practitioner (GP) registration and restricted marketing]. Specific antibiotic use was found to be a significant determinant of resistance for some but not all drug/organism combinations. Incentives to stimulate GP gatekeeping were associated with lower levels of resistance, and life expectancy at age 65 and atheism were associated with more resistance.Myriad factors influence antibiotic use and resistance at the country level and an important part of these can be modified by policy choices.