Livermore David M, Reynolds Rosy, Stephens Peter, Duckworth Georgia, Felmingham David, Johnson Alan P, Murchan Stephen, Murphy Olive, Gungabissoon Usha, Waight Pauline, Pebody Richard, Shackcloth Jemma, Warner Marina, Williams Laura, George Robert C
Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK.
Int J Antimicrob Agents. 2006 Oct;28(4):273-9. doi: 10.1016/j.ijantimicag.2006.05.025. Epub 2006 Sep 14.
It is widely believed that reducing antimicrobial usage should reduce resistance, although observational evidence is mixed. Pneumococci make ideal subjects to test this belief as they are widely surveyed and lack an animal reservoir. Accordingly, susceptibility data for pneumococci in the UK and Ireland were retrieved from the Health Protection Agency's LabBase/CoSurv system and from the European Antimicrobial Resistance Surveillance System (EARSS) and British Society for Antimicrobial Chemotherapy (BSAC) databases. The BSAC surveillance examines respiratory pneumococci; the other systems focus upon invasive organisms only, with the LabBase/CoSurv system being the most comprehensive, capturing data on most bacteraemias in England and Wales. National pharmacy sales data were obtained from the IMS Health MIDAS database and were modelled to the resistance data by logistic and linear regression analysis. All systems except for the BSAC respiratory surveillance data indicated that penicillin resistance has fallen significantly since 1999 in the UK, whereas macrolide resistance has been essentially stable, or has risen slightly. The data for Ireland were based on smaller sample sizes but suggested a fall in penicillin non-susceptibility from 1999 to 2004, with conflicting evidence for macrolide resistance. The recent decreasing trend in penicillin resistance is in contrast to a rising trend in England and Wales until (at least) 1997 and strongly rising macrolide resistance from 1989 to 1993. UK pharmacy sales of macrolides and oral beta-lactams fell by ca. 30% in the late 1990s following increased concern about resistance, before stabilising or rising weakly; sales in Ireland were stable or rose slightly in the study period. We conclude that falling penicillin resistance in pneumococci followed reduced sales of oral beta-lactams to pharmacies in the UK, but a similar fall in macrolide sales was not associated with any fall in resistance. Stabilisation or decline in penicillin resistance has occurred in Ireland despite stable or increasing oral beta-lactam sales.
人们普遍认为，减少抗菌药物的使用应该能降低耐药性，尽管观察性证据并不一致。肺炎球菌是检验这一观点的理想对象，因为它们受到广泛监测且不存在动物宿主。因此，从英国健康保护局的LabBase/CoSurv系统、欧洲抗菌药物耐药性监测系统（EARSS）以及英国抗菌化疗协会（BSAC）数据库中获取了英国和爱尔兰肺炎球菌的药敏数据。BSAC监测的是呼吸道肺炎球菌；其他系统仅关注侵袭性微生物，其中LabBase/CoSurv系统最为全面，记录了英格兰和威尔士大多数菌血症的数据。国家药房销售数据来自艾美仕市场研究公司（IMS Health）的MIDAS数据库，并通过逻辑回归和线性回归分析与耐药性数据进行建模。除BSAC呼吸道监测数据外，所有系统均表明，自1999年以来，英国的青霉素耐药性显著下降，而大环内酯类耐药性基本稳定或略有上升。爱尔兰的数据样本量较小，但显示1999年至2004年青霉素不敏感性有所下降，大环内酯类耐药性的证据相互矛盾。近期青霉素耐药性的下降趋势与英格兰和威尔士至少到1997年的上升趋势形成对比，以及1989年至1993年大环内酯类耐药性的强劲上升形成对比。20世纪90年代末，随着对耐药性的担忧增加，英国药房大环内酯类和口服β-内酰胺类药物的销售额下降了约30%，之后趋于稳定或略有上升；在研究期间，爱尔兰的销售额稳定或略有上升。我们得出结论，英国肺炎球菌青霉素耐药性的下降与药房口服β-内酰胺类药物销售额的减少有关，但大环内酯类药物销售额的类似下降与耐药性的任何下降均无关。尽管爱尔兰口服β-内酰胺类药物销售额稳定或增加，但青霉素耐药性已趋于稳定或下降。
