Outpatient Antibiotic Prescribing and Nonsusceptible Streptococcus pneumoniae in the United States, 1996-2003
Outpatient Antibiotic Prescribing and Nonsusceptible Streptococcus pneumoniae in the United States, 1996-2003
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DOI：
10.1093/cid/cir443
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发表时间：
2011-10-01
影响因子：
11.8
通讯作者：
Klugman, Keith P.
中科院分区：
文献类型：
--
作者：
Hicks, Lauri A.;Chien, Yu-Wen;Klugman, Keith P.
背景随着抗生素耐药性的传播，肺炎链球菌感染变得越来越复杂和昂贵。我们评估了抗生素处方与侵袭性肺炎球菌病（IPD）分离株不敏感性之间的关系。从IMS Health Xcomponent数据库中提取青霉素类、头孢菌素类、大环内酯类和甲氧苄啶-磺胺甲恶唑类的门诊抗生素处方数据，以计算人均年处方数。我们分析了来自疾病控制和预防中心的7个活跃细菌核心监测点（人口1860万）的IPD数据，这些数据在整个研究期间（1996-2003）都是可用的。Logistic回归模型用于评估抗生素处方率高的地点是否有高比例的非敏感和血清型19 A IPD。1996-2003年期间，5岁以下儿童的年处方率下降了42%，从0.98降至0.57（P <0.001）;两组阿奇霉素处方均有所增加。抗生素处方率高的研究中心对IPD不敏感的比例高于抗生素处方率低的研究中心（青霉素P = 0.003，其他抗生素P <0.001）。头孢菌素和大环内酯类处方与青霉素和多药不敏感性和血清型19 A IPD相关（P < .001）。在抗生素处方率高的地区，非敏感性IPD的比例也很高，这表明当地处方实践有助于当地耐药模式。头孢菌素类和大环内酯类似乎是青霉素和多重耐药肺炎球菌，以及血清型19 A IPD的选择。抗生素的使用是导致抗生素耐药性蔓延的一个主要因素;减少抗生素耐药性的战略应继续包括明智地使用抗生素。
Background. Streptococcus pneumoniae infections have become increasingly complicated and costly to treat with the spread of antibiotic resistance. We evaluated the relationship between antibiotic prescribing and nonsusceptibility among invasive pneumococcal disease (IPD) isolates.Methods. Outpatient antibiotic prescription data for penicillins, cephalosporins, macrolides, and trimethoprim-sulfamethoxazole were abstracted from the IMS Health Xponent database to calculate the annual number of prescriptions per capita. We analyzed IPD data from 7 of the Centers for Disease Control and Prevention's Active Bacterial Core surveillance sites (population, 18.6 million) for which data were available for the entire time period under study (1996-2003). Logistic regression models were used to assess whether sites with high antibiotic prescribing rates had a high proportion of nonsusceptible and serotype 19A IPD.Results. Yearly prescribing rates during the period 1996-2003 for children = 5 years of age decreased by 42%, from 0.98 to 0.57 prescriptions per capita per year (P < .001); increases in azithromycin prescribing were noted for both groups. Sites with high rates of antibiotic prescribing had a higher proportion of IPD nonsusceptibility than did low-prescribing sites (P = .003 for penicillin, P < .001 for every other antibiotic class). Cephalosporin and macrolide prescribing were associated with penicillin and multidrug nonsusceptibility and serotype 19A IPD (P < .001).Conclusions. In sites where antibiotic prescribing is high, the proportion of nonsusceptible IPD is also high, suggesting that local prescribing practices contribute to local resistance patterns. Cephalosporins and macrolides seem to be selecting for penicillin-and multidrug-resistant pneumococci, as well as serotype 19A IPD. Antibiotic use is a major factor contributing to the spread of antibiotic resistance; strategies to reduce antibiotic resistance should continue to include judicious use of antibiotics.