Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey
Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey
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DOI：
10.1136/bmjopen-2018-023859
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Cook, Alex R.
中科院分区：
文献类型：
--
作者：
Mo, Yin;Seah, Ivan;Cook, Alex R.
目的了解抗生素使用知识、态度和行为（KAP）与产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）感染流行病学及分子特征的相关性，以确定可改变的因素和公共卫生干预措施，以减少社区中多重耐药微生物定植的流行。对抗生素使用和粪便样本或直肠拭子采集的KAP分段问卷。研究对象：新加坡人口稠密的社区，共收集693名健康的社区居民问卷调查对象。结果调查对象对抗生素使用知识的知晓率较低，平均得分为4.6/10，IQR为3.0-6.0。80例受试者（80/305，26.2%）携带至少一种ESBL-PE分离株。最常见的ESBL-PE是携带CTX-M型β-内酰胺酶的大肠埃希菌131型（11/71，15.5%）。在海外生活>1年（OR 3.3，95%CI 1.6 - 6.9）但不是短期旅行，近期住院或抗生素摄入与ESBL-PE携带相关。有趣的是，（OR 2.0，95% CI 1.03 - 3.9）且无抗生素残留（OR 2.4，95%CI 1.2 ~ 4.9）是多因素Logistic回归模型中与ESBL-PE携带相关的独立因素。我们可能须研究现时有关必须完成所有抗生素疗程的建议。确定常见感染的最佳治疗持续时间的临床试验至关重要。
Objectives To study the correlation between knowledge, attitude and practices (KAP) of antibiotic consumption with epidemiology and molecular characteristics of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage, in order to identify modifiable factors and public health interventions to reduce prevalence of multidrug-resistant organism colonisation in the community.Design Cross-sectional questionnaire of KAP towards antibiotic use and collection of stool samples or rectal swabs. ESBL-PE isolates obtained underwent whole genome sequencing to identify resistance genes.Setting A densely populated community in Singapore.Participants There were 693 healthy community-dwelling questionnaire respondents. Out of which, 305 provided stool samples or rectal swabs.Results The overall knowledge of antibiotic use was poor (mean score 4.6/10, IQR 3.0-6.0). 80 participants (80/305, 26.2%) carried at least one ESBL-PE isolate. The most common ESBL-PE was Escherichia coli sequence type 131 carrying CTX-M type beta-lactamases (11/71, 15.5%). Living overseas for >1 year (OR 3.3, 95% CI 1.6 to 6.9) but not short-term travel, recent hospitalisation or antibiotic intake was associated with ESBL-PE carriage. Interestingly, higher knowledge scores (OR 2.0, 95% CI 1.03 to 3.9) and having no leftover antibiotics (OR 2.4, 95% CI 1.2 to 4.9) were independent factors associated with ESBL-PE carriage in the multivariate logistic regression model.Conclusions While the role of trans-border transmission of antimicrobial resistance is well known, we may have to examine the current recommendation that all antibiotics courses have to be completed. Clinical trials to determine the optimum duration of treatment for common infections are critically important.