Kwan-Gett T S, Davis R L, Shay D K, Black S, Shinefield H, Koepsell T
Virginia Mason Medical Center Department of Pediatrics, Seattle, WA, USA.
Epidemiol Infect. 2002 Dec;129(3):499-505. doi: 10.1017/s0950268802007616.
We used microbiology and pharmacy data from health-maintenance organizations to determine whether antibiotic use by a household member increases the risk of penicillin-non-susceptible pneumococcal disease. Though it has been well established that an individual's antibiotic use increases one's risk of antibiotic-resistant infection, it is unclear whether the risk is increased if a member of one's household is exposed to antibiotics. We therefore conducted a case-control study of patients enrolled in health maintenance organizations in Western Washington and Northern California. Cases were defined as individuals with penicillin-non-susceptible pneumococcal infection; controls were individuals with penicillin-susceptible pneumococcal infection. Socioeconomic variables were obtained by linking addresses with 1997 census block group data. One-hundred and thirty-four cases were compared with 798 controls. Individual antibiotic use prior to diagnosis increased the odds of penicillin non-susceptibility, with the strongest effect seen for beta-lactam use within 2 months (OR 1.8, 95% CI 1.2, 2.8). When household antibiotic use by persons other than the patient were considered, at 4 months prior to diagnosis there was a trend towards an association between penicillin non-susceptibility and beta-lactam antibiotic use, and a possible association in a small subgroup of patients with eye and ear isolates. However, no significant overall pattern of association was seen. We conclude that though antibiotic use of any kind within 2 months prior to diagnosis is associated with an increased risk of penicillin-non-susceptible pneumococcal disease, there is no significant overall pattern of association between household antibiotic use and penicillin-non-susceptible pneumococcal infection.
我们利用健康维护组织的微生物学和药学数据，以确定家庭成员使用抗生素是否会增加对青霉素不敏感的肺炎球菌疾病的风险。尽管个体使用抗生素会增加其发生抗生素耐药性感染的风险这一点已得到充分证实，但尚不清楚如果家庭成员接触抗生素，风险是否会增加。因此，我们对华盛顿州西部和北加利福尼亚州健康维护组织登记的患者进行了一项病例对照研究。病例定义为患有对青霉素不敏感的肺炎球菌感染的个体；对照为患有对青霉素敏感的肺炎球菌感染的个体。通过将地址与1997年人口普查街区组数据相链接来获取社会经济变量。将134例病例与798例对照进行比较。诊断前个体使用抗生素增加了对青霉素不敏感的几率，在诊断前2个月内使用β-内酰胺类抗生素的影响最为显著（比值比1.8，95%置信区间1.2, 2.8）。当考虑患者以外的家庭成员使用抗生素的情况时，在诊断前4个月，对青霉素不敏感与使用β-内酰胺类抗生素之间存在关联趋势，在一小部分眼部和耳部分离株患者中存在可能的关联。然而，未观察到显著的总体关联模式。我们得出结论，尽管诊断前2个月内使用任何类型的抗生素都与对青霉素不敏感的肺炎球菌疾病风险增加相关，但家庭抗生素使用与对青霉素不敏感的肺炎球菌感染之间不存在显著的总体关联模式。
