Samore Matthew H, Lipsitch Marc, Alder Stephen C, Haddadin Bassam, Stoddard Greg, Williamson Jacquelyn, Sebastian Katherine, Carroll Karen, Ergonul Onder, Carmeli Yehuda, Sande Merle A
Division of Clinical Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA.
Am J Epidemiol. 2006 Jan 15;163(2):160-70. doi: 10.1093/aje/kwj021. Epub 2005 Nov 30.
Mechanisms by which antimicrobials contribute to dissemination of pneumococcal resistance are incompletely characterized. A serial cross-sectional study of nasopharyngeal pneumococcal carriage in healthy, home-living children <or=6 years of age was conducted in four rural communities-two in Utah (1998-2003) and two in Idaho (2002-2003). Prevalence odds ratios for carriage of resistant pneumococci (OR(res)) and of susceptible pneumococci (OR(sus)) were estimated. Dynamic transmission models were developed to facilitate a mechanistic interpretation of OR(res) and OR(sus) and to compare the population impact of distinct antimicrobial classes. A total of 5,667 cultures were obtained; 25% of the cultures were positive, and 29% of isolates exhibited reduced susceptibility to penicillin. The adjusted OR(res) for recent individual and sibling cephalosporin use was 2.2 (95% confidence interval: 1.4, 3.4) and 1.8 (95% confidence interval: 1.0, 3.3), respectively. Neither individual nor sibling penicillin use was associated with increased OR(res). Rather, recent use of penicillins was associated with decreased carriage of susceptible pneumococci (OR(sus) = 0.2, 95% confidence interval: 0.1, 0.3). In simulations, both types of effects promoted dissemination of resistant pneumococci at the population level. Findings show that oral cephalosporins enhance the risk of acquiring resistant pneumococci. Penicillins accelerate clearance of susceptible strains. The effect of penicillins in increasing resistance is shared equally by treated and untreated members of the population.
抗菌药物促进肺炎球菌耐药性传播的机制尚未完全明确。在四个农村社区（犹他州的两个社区，时间为1998 - 2003年；爱达荷州的两个社区，时间为2002 - 2003年）对6岁及以下居家生活的健康儿童进行了一项关于鼻咽部肺炎球菌携带情况的系列横断面研究。估算了携带耐药肺炎球菌（OR(res)）和敏感肺炎球菌（OR(sus)）的患病率比值比。建立了动态传播模型，以便从机制上解释OR(res)和OR(sus)，并比较不同抗菌药物类别对人群的影响。共获得5667份培养物；25%的培养物呈阳性，29%的分离株对青霉素的敏感性降低。近期个体及同胞使用头孢菌素的校正OR(res)分别为2.2（95%置信区间：1.4, 3.4）和1.8（95%置信区间：1.0, 3.3）。个体及同胞使用青霉素均与OR(res)升高无关。相反，近期使用青霉素与敏感肺炎球菌携带率降低有关（OR(sus) = 0.2，95%置信区间：0.1, 0.3）。在模拟中，这两种效应均在人群水平上促进了耐药肺炎球菌的传播。研究结果表明，口服头孢菌素会增加获得耐药肺炎球菌的风险。青霉素会加速敏感菌株的清除。青霉素增加耐药性的效应在人群中接受治疗和未接受治疗的成员中是相同的。
