A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance.
A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance.
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DOI：
10.1186/1471-2334-14-13
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发表时间：
2014-01-09
影响因子：
3.7
通讯作者：
Pringle M
中科院分区：
文献类型：
--
作者：
Bell BG;Schellevis F;Stobberingh E;Goossens H;Pringle M
在过去的50年里，抗生素的大量使用对敏感细菌施加了选择性压力，可能有利于耐药菌株的生存。关于在社区患者中传播的病原体的抗生素耐药性模式的现有信息大大少于住院患者的信息，而住院患者的指南通常是以住院患者为基础的。因此，我们选择评估在社区中流通的细菌的抗药性模式与社区中抗生素消费之间的关系。对灰色文献和用英语和其他欧洲语言出版的科学文献进行了检查。使用多元回归分析研究是否发现抗生素用量与耐药性之间存在正相关关系。随后的荟萃分析和荟萃回归用于可以计算共同效应大小测量(优势比)的研究。电子搜索确定了974项研究，但只有243项研究被提取数据的两名独立审查员认为符合纳入条件。二项检验显示抗生素用量与耐药性呈正相关(p <； .001)，但多元回归模型没有对研究结果产生任何显着的预测因素。Meta分析得出显著的合并优势比为2.3(95%可信区间为2.2%至2.5%)，Meta回归得出几个有意义的预测因素(F(10，77) = 5.82，p <； .01)。与其他地区相比，南欧国家的消费和抵抗力之间的联系更强。通过大量研究，我们发现抗生素的使用与抗生素耐药性的产生有关。随后的荟萃分析，结合研究的子样本，得出了几个重要的预测因素。与其他地区相比，南欧国家在消费和耐药性之间的联系更强，因此可能需要在这一领域加强减少抗生素消费的努力。抗生素消费的增加不仅可能在个体患者层面产生更大的耐药性，而且还可能在社区、国家和地区层面产生更大的耐药性，从而可能损害个体患者。
Greater use of antibiotics during the past 50 years has exerted selective pressure on susceptible bacteria and may have favoured the survival of resistant strains. Existing information on antibiotic resistance patterns from pathogens circulating among community-based patients is substantially less than from hospitalized patients on whom guidelines are often based. We therefore chose to assess the relationship between the antibiotic resistance pattern of bacteria circulating in the community and the consumption of antibiotics in the community. Both gray literature and published scientific literature in English and other European languages was examined. Multiple regression analysis was used to analyse whether studies found a positive relationship between antibiotic consumption and resistance. A subsequent meta-analysis and meta-regression was conducted for studies for which a common effect size measure (odds ratio) could be calculated. Electronic searches identified 974 studies but only 243 studies were considered eligible for inclusion by the two independent reviewers who extracted the data. A binomial test revealed a positive relationship between antibiotic consumption and resistance (p < .001) but multiple regression modelling did not produce any significant predictors of study outcome. The meta-analysis generated a significant pooled odds ratio of 2.3 (95% confidence interval 2.2 to 2.5) with a meta-regression producing several significant predictors (F(10,77) = 5.82, p < .01). Countries in southern Europe produced a stronger link between consumption and resistance than other regions. Using a large set of studies we found that antibiotic consumption is associated with the development of antibiotic resistance. A subsequent meta-analysis, with a subsample of the studies, generated several significant predictors. Countries in southern Europe produced a stronger link between consumption and resistance than other regions so efforts at reducing antibiotic consumption may need to be strengthened in this area. Increased consumption of antibiotics may not only produce greater resistance at the individual patient level but may also produce greater resistance at the community, country, and regional levels, which can harm individual patients.