Cizman Milan, Beović Bojana, Seme Katja, Paragi Metka, Strumbelj Iztok, Müller-Premru Manica, Cad-Pecar Silva, Pokorn Marko
University Medical Centre, Department of Infectious Diseases, Japljeva 2, 1525 Ljubljana, Slovenia.
Int J Antimicrob Agents. 2006 Dec;28(6):537-42. doi: 10.1016/j.ijantimicag.2006.07.023. Epub 2006 Nov 13.
The aim of this study was to investigate the association between decreased use of macrolides and resistance of common respiratory pathogens in Slovenia from 1999 to 2004. Over a 6-year period the consumption of macrolides in Slovenia decreased by 21.3%, from 3.81 defined daily doses/1000 inhabitants per day (DID) to 3.0 DID. The use of short-acting, intermediate-acting and long-acting subclasses of macrolides decreased by 50%, 18% and 13%, respectively. In the same period, resistance of invasive strains of Streptococcus pneumoniae increased from 4.6% to 11.1% and resistance of non-invasive strains of S. pneumoniae and Streptococcus pyogenes increased from 12.8% to 20.2% and from 7.4% to 12.5%, respectively. Resistance increased significantly more in children than in adults (P=0.05) and was significantly correlated with increased use of intermediate-acting macrolides (r=0.94 for non-invasive S. pneumoniae and r=0.96 for S. pyogenes) in children. Resistance of Haemophilus influenzae and Moraxella catarrhalis was low and did not change. In children and adults, the emergence and spread of multidrug-resistant strains of invasive S. pneumoniae was observed. The decline in total macrolide use was not paralleled by reduced macrolide resistance rates of S. pyogenes and S. pneumoniae during the 6-year period. There was a strong correlation between the use of intermediate-acting macrolides and macrolide resistance of S. pyogenes and S. pneumoniae in children. Further reduction in the use of intermediate- and long-acting macrolides should be encouraged.
本研究旨在调查1999年至2004年期间斯洛文尼亚大环内酯类药物使用减少与常见呼吸道病原体耐药性之间的关联。在6年时间里，斯洛文尼亚大环内酯类药物的消费量下降了21.3%，从每日每1000居民3.81限定日剂量（DID）降至3.0 DID。短效、中效和长效大环内酯类药物的使用分别下降了50%、18%和13%。同期，侵袭性肺炎链球菌菌株的耐药性从4.6%增至11.1%，非侵袭性肺炎链球菌和化脓性链球菌菌株的耐药性分别从12.8%增至20.2%和从7.4%增至12.5%。儿童的耐药性增加显著高于成人（P = 0.05），且与儿童中效大环内酯类药物使用增加显著相关（非侵袭性肺炎链球菌的r = 0.94，化脓性链球菌的r = 0.96）。流感嗜血杆菌和卡他莫拉菌的耐药性较低且未发生变化。在儿童和成人中，均观察到侵袭性肺炎链球菌多重耐药菌株的出现和传播。在这6年期间，化脓性链球菌和肺炎链球菌的大环内酯类耐药率并未随大环内酯类药物总使用量的下降而降低。儿童中效大环内酯类药物的使用与化脓性链球菌和肺炎链球菌的大环内酯类耐药性之间存在很强的相关性。应鼓励进一步减少中效和长效大环内酯类药物的使用。
