Guillemot D, Leclercq R
Centre de ressource en biostatistiques, epidémiologie et pharmaco-epidémiologie appliquées aux maladies infectieuses, Institut Pasteur, Paris, France.
Med Mal Infect. 2005 Aug;35 Suppl 3:S212-20.
Exposure of populations to antibiotics is a condition for the emergence and the diffusion of bacteria resistant to antibiotics. Analysis of epidemiological causality between antibiotic exposure and expansion of antibiotic resistance in human pathogens requires the study of the basis for the emergence and the subsequent epidemic spread of the strains. Emergence of antibiotic resistance under the selective pressure of antibiotics is unavoidable. However, the rapidity of the emergence depends on several parameters including the biochemical mechanism and the genetic support of the resistance and on the couple bacteria/antibiotic considered. Several of these parameters may be studied and measured in vitro. In vivo, relationship between antibiotic exposure and risk for infection or colonisation by pneumococci resistant to beta-lactams or macrolides and methicillin-resistant staphylococci are among the best studied models. In particular for pneumococci, quantitative relationship between antibiotic consumption and resistance, including geographical correlations have been shown but do not allow to establish any causality relationship. Overall, there is no doubt on the question of the impact of antibiotic exposure and the risk of antibiotic resistance. However, the quantification of the risks remains to be accurately studied.
人群接触抗生素是对抗生素耐药细菌出现和传播的一个条件。分析抗生素接触与人类病原体中抗生素耐药性扩展之间的流行病学因果关系，需要研究菌株出现及随后流行传播的基础。在抗生素的选择压力下，抗生素耐药性的出现是不可避免的。然而，出现的速度取决于几个参数，包括耐药性的生化机制和遗传支持，以及所考虑的细菌/抗生素组合。其中一些参数可以在体外进行研究和测量。在体内，抗生素接触与对β-内酰胺类或大环内酯类耐药的肺炎球菌以及耐甲氧西林葡萄球菌的感染或定植风险之间的关系是研究得最好的模型之一。特别是对于肺炎球菌，已显示抗生素消费与耐药性之间的定量关系，包括地理相关性，但无法确立任何因果关系。总体而言，抗生素接触的影响以及抗生素耐药性风险这一问题毫无疑问。然而，风险的量化仍有待准确研究。
