Lipsitch M
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
Clin Infect Dis. 2001 Apr 1;32(7):1044-54. doi: 10.1086/319604. Epub 2001 Mar 23.
Studies of the relationship between antibiotic use and resistance in pneumococci have produced conflicting results, reflecting differences in study design, setting, and measures of association used. Mathematical models of pneumococcal transmission dynamics provide a framework for interpreting and reconciling these studies. The model predicts, and the review of published studies confirms, that treatment often has little effect in increasing an individual's absolute risk of carrying/being infected by penicillin-resistant Streptococcus pneumoniae (PRSP). However, treatment substantially increases a patient's risk of carriage of/infection by PRSP relative to that of penicillin-susceptible S. pneumoniae (PSSP). The appropriate measure of association depends on the question of interest. Antibiotic use can substantially increase the prevalence of risk in the community as a whole, even when there is a small or nonexistent effect of treatment on the absolute risk that a treated individual will carry a resistant organism. Recommendations for the design and analysis of future studies of antibiotic treatment and pneumococcal resistance are proposed.
关于抗生素使用与肺炎球菌耐药性之间关系的研究得出了相互矛盾的结果，这反映出研究设计、研究背景以及所采用的关联度量方法存在差异。肺炎球菌传播动力学的数学模型为解释和协调这些研究提供了一个框架。该模型预测，并且对已发表研究的综述也证实，治疗通常对增加个体携带/感染耐青霉素肺炎链球菌（PRSP）的绝对风险影响甚微。然而，相对于青霉素敏感肺炎链球菌（PSSP）而言，治疗会大幅增加患者携带/感染PRSP的风险。合适的关联度量方法取决于所关注的问题。抗生素的使用能够大幅增加整个社区的风险流行率，即便治疗对接受治疗个体携带耐药菌的绝对风险影响很小或不存在影响。本文还针对未来抗生素治疗与肺炎球菌耐药性研究的设计和分析提出了建议。
