Communicating trends in resistance using a drug resistance index
Communicating trends in resistance using a drug resistance index
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DOI：
10.1136/bmjopen-2011-000135
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发表时间：
2011-01-01
期刊：
影响因子：
2.9
通讯作者：
Klugman, Keith P.
中科院分区：
文献类型：
--
作者：
Laxminarayan, Ramanan;Klugman, Keith P.
背景资料：抗生素耐药性是全球范围内日益严重的问题，但由于细菌病原体的多样性和用于治疗它们的不同类别的抗生素，将这一挑战传达给政策制定者和非专家变得复杂。即使是了解抗生素药效学的专家，在没有关于抗生素使用频率和是否有替代抗生素的信息的情况下，也很难推断耐药性的严重性。在聚合耐多药评估趋势的困难带来了进一步的挑战，随着时间的推移和跨locations.Methods：我们开发了一种方法聚合细菌耐多抗生素，创建一个指数可比的综合经济指数，衡量消费者价格和股票市场价值的耐药性变化的量化和沟通。由此产生的耐药指数（DRI）和各种子指数显示在美国的抗生素耐药性和消费趋势，但可以应用在任何地理水平。结果：DRI的基础上使用模式在1999年大肠杆菌上升从0.25（95%CI 0.23至0.26）至0.30（95%CI 0.29至0.32）之间，1999年和2006年。然而，适应性DRI（包括使用替代药物治疗基线耐药菌株）在此期间从0.25攀升至0.27（95%CI 0.25至0.28）。与此相反，静态使用和适应性DRI的不动杆菌属。从1999年到2006年，大肠杆菌的耐药性从0.41（95%CI 0.4 ~ 0.42）上升到0.48（95%CI 0.46 ~ 0.49）。解释：大肠杆菌静态使用和适应性使用DRIs之间的差异反映了医生适应耐药性增加的能力。然而，抗生素的使用模式并没有因为不动杆菌耐药性的增加而发生很大变化。因为医生无法适应;不动杆菌属的新药。因此需要。汇总对各种药物的耐药性的综合指数可用于评估耐药性在时间和空间上的变化。
Background: Antibiotic resistance is a growing problem worldwide, but communicating this challenge to policymakers and non-experts is complicated by the multiplicity of bacterial pathogens and the distinct classes of antibiotics used to treat them. It is difficult, even for experts aware of the pharmacodynamics of antibiotics, to infer the seriousness of resistance without information on how commonly the antibiotic is being used and whether alternative antibiotics are available. Difficulty in aggregating resistance to multiple drugs to assess trends poses a further challenge to quantifying and communicating changes in resistance over time and across locations.Methods: We developed a method for aggregating bacterial resistance to multiple antibiotics, creating an index comparable to the composite economic indices that measure consumer prices and stock market values. The resulting drug resistance index (DRI) and various subindices show antibiotic resistance and consumption trends in the USA but can be applied at any geographical level.Findings: The DRI based on use patterns in 1999 for Escherichia coli rose from 0.25 (95% CI 0.23 to 0.26) to 0.30 (95% CI 0.29 to 0.32) between 1999 and 2006. However, the adaptive DRI, which includes treatment of baseline resistant strains with alternative agents, climbed from 0.25 to 0.27 (95% CI 0.25 to 0.28) during that period. In contrast, both the static-use and the adaptive DRIs for Acinetobacter spp. rose from 0.41 (95% CI 0.4 to 0.42) to 0.48 (95% CI 0.46 to 0.49) between 1999 and 2006.Interpretation: Divergence between the static-use and the adaptive-use DRIs for E coli reflects the ability of physicians to adapt to increasing resistance. However, antibiotic use patterns did not change much in response to growing resistance to Acinetobacter spp. because physicians were unable to adapt; new drugs for Acinetobacter spp. are therefore needed. Composite indices that aggregate resistance to various drugs can be useful for assessing changes in drug resistance across time and space.