Estimating the Treatment of Carbapenem-Resistant Enterobacteriaceae Infections in the United States Using Antibiotic Prescription Data
Estimating the Treatment of Carbapenem-Resistant Enterobacteriaceae Infections in the United States Using Antibiotic Prescription Data
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DOI：
10.1093/ofid/ofz344
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发表时间：
2019-08-01
影响因子：
4.2
通讯作者：
Nguyen, M. Hong
中科院分区：
文献类型：
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作者：
Clancy, Cornelius J.;Potoski, Brian A.;Nguyen, M. Hong
背景多粘菌素类（粘菌素、多粘菌素B）是治疗碳青霉烯类耐药肠杆菌科（CRE）感染的一线抗生素。与多粘菌素类相比，新型抗CRE抗生素（头孢他啶-阿维巴坦、美罗培南-戊硼巴坦、普拉佐霉素）可改善CRE感染患者的结局并降低毒性。目前还不清楚多粘菌素和新的药物用于治疗CRE感染的广泛程度。我们对美国医院的药剂师进行了一项在线调查，以确定针对CRE感染的抗生素定位。使用IQVIA处方数据和推动研发再投资和负责任抗生素使用（DRIVE-AB）CRE感染估计值，确定美国所有感染和使用不同抗生素治疗的CRE感染数量。在接受调查的美国医院中，头孢他啶-阿维巴坦、美罗培南-伐博巴坦或普拉佐霉素分别被87%、90%、83%和56%的医院列为治疗CRE肺炎、菌血症、腹腔内感染和尿路感染的一线药物。从2018年2月至2019年1月，估计分别有9437例和7941例CRE感染接受了静脉内多粘菌素或新药治疗;这些数字分别相当于美国CRE感染的28%（范围，19%-50%）和23%（范围，16%-42%）。截至2018年12月，头孢他啶-阿维巴坦、美罗培南-戊硼巴坦或普拉佐霉素的使用超过了静脉内多粘菌素治疗CRE感染的使用。目前，估计这些新药可治疗35%（23%至62%）的CRE感染，预计它们将成为一线药物。新的抗CRE药物最近超过了静脉注射多粘菌素作为CRE感染的治疗，但在美国医院的使用低于预期。需要研究影响新抗生素使用的行为和经济因素，以及促进经济上可行的市场的财政“拉动”激励措施。
Background. Polymyxins (colistin, polymyxin B) have been first-line antibiotics against carbapenem-resistant Enterobacteriaceae (CRE) infections. New anti-CRE antibiotics (ceftazidime-avibactam, meropenem-vaborbactam, plazomicin) improve outcomes in CRE-infected patients and reduce toxicity compared with polymyxins. It is unclear how widely polymyxins and newer agents are used to treat CRE infections.Methods. We conducted an online survey of US hospital-based pharmacists to determine antibiotic positioning against CRE infections. Numbers of all infections and CRE infections treated with different antibiotics in the United States were determined using IQVIA prescription data and Driving Re-investment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) estimates of CRE infections.Results. Ceftazidime-avibactam, meropenem-vaborbactam, or plazomicin were positioned as first-line agents against CRE pneumonia, bacteremia, intra-abdominal infections, and urinary tract infections at 87%, 90%, 83%, and 56% of surveyed US hospitals, respectively. From February 2018 to January 2019, an estimated 9437 and 7941 CRE infections were treated with an intravenous polymyxin or new agent, respectively; these figures represented similar to 28% (range, 19%-50%) and similar to 23% (range, 16%-42%) of CRE infections in the United States. Use of ceftazidime-avibactam, meropenem-vaborbactam, or plazomicin exceeded that of intravenous polymyxins against CRE infections as of December 2018. Currently, the new drugs are estimated to treat 35% (23% to 62%) of CRE infections in which they were expected to be first-line agents.Conclusions. New anti-CRE agents recently surpassed intravenous polymyxins as treatment for CRE infections, but use is less than expected from their positioning at US hospitals. Research on behavioral and economic factors that impact use of new antibiotics is needed, as are financial "pull" incentives that promote an economically viable marketplace.