Granizo J J, Aguilar L, Casal J, García-Rey C, Dal-Ré R, Baquero F
Research Area, Fundación Jiménez Díaz, Madrid. Medical Department, SmithKline Beecham Pharmaceuticals, C/Valle de la Fuenfría no. 3, D-28034 Madrid, Spain.
J Antimicrob Chemother. 2000 Nov;46(5):767-73. doi: 10.1093/jac/46.5.767.
Streptococcus pneumoniae resistance to penicillin and erythromycin in relation to beta-lactam and macrolide consumption in Spain over 19 years (1979-1997) was studied from resistance data collected by a search of the literature. Antibiotic consumption was expressed in defined daily dosage (DDD)/1000 inhabitants/day. A significant relationship (P: < 0.001) between erythromycin resistance (MIC >/= 1 mg/L) and global macrolide consumption (r = 0.942), as well as between high-level penicillin resistance (MIC >/= 2 mg/L) and global beta-lactam consumption (r = 0.948) was observed. The relationship between erythromycin resistance and macrolide consumption was due mainly to consumption of macrolides taken twice a day (adjusted r(2) = 0.886). Prevalence of high-level penicillin resistance correlated with consumption of oral cephalosporins (adjusted r(2) = 0.877); however, there appeared to be no correlation of consumption of oral or parenteral aminopenicillins, narrow-spectrum penicillins or cephalosporins with intermediate-level penicillin resistance (MIC 0. 12-1 mg/L). The prevalence of high-level penicillin and of erythromycin resistance were also strongly correlated with each other (r = 0.903, P: < 0.001). In addition to global consumption, different categories of resistance (high or intermediate), and the differential capability of antibiotics to select resistance, must be taken into account when studying antibiotic impact on bacterial populations. Although this ecological analysis is not able to demonstrate a causal relationship between antibiotic consumption and development of resistance, it suggests that overuse of certain specific antibiotics is more likely to be related to the increase in drug-resistant strains of S. pneumoniae.
通过检索文献收集的耐药数据，研究了19年（1979 - 1997年）间西班牙肺炎链球菌对青霉素和红霉素的耐药性与β-内酰胺类和大环内酯类药物消费的关系。抗生素消费量以限定日剂量（DDD）/1000居民/天表示。观察到红霉素耐药性（MIC≥1mg/L）与大环内酯类药物总消费量之间存在显著关系（P：<0.001，r = 0.942），以及高水平青霉素耐药性（MIC≥2mg/L）与β-内酰胺类药物总消费量之间存在显著关系（r = 0.948）。红霉素耐药性与大环内酯类药物消费之间的关系主要归因于每日服用两次的大环内酯类药物的消费（调整后的r² = 0.886）。高水平青霉素耐药性的患病率与口服头孢菌素的消费量相关（调整后的r² = 0.877）；然而，口服或胃肠外氨基青霉素、窄谱青霉素或头孢菌素的消费量与中等水平青霉素耐药性（MIC 0.12 - 1mg/L）之间似乎没有相关性。高水平青霉素耐药性和红霉素耐药性的患病率也彼此高度相关（r = 0.903，P：<0.001）。在研究抗生素对细菌群体的影响时，除了总消费量外，还必须考虑不同类别的耐药性（高或中等）以及抗生素选择耐药性的不同能力。虽然这种生态学分析无法证明抗生素消费与耐药性发展之间的因果关系，但它表明某些特定抗生素的过度使用更有可能与肺炎链球菌耐药菌株的增加有关。
