Hyle Emily P, Bilker Warren B, Gasink Leanne B, Lautenbach Ebbing
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
Infect Control Hosp Epidemiol. 2007 Jun;28(6):647-54. doi: 10.1086/516798. Epub 2007 May 10.
Many studies have investigated the association between prior antibiotic use and antibiotic resistance. However, methods used in past studies to describe the extent of prior antibiotic use (eg, use of the 2 categories exposure versus no exposure and measurement of duration of exposure) have not been reviewed. The impact of the use of different methods for quantifying the use of antibiotics is unknown. The objectives of this study were to characterize past approaches to describing the extent of antibiotic use and to identify the impact of the use of different methods on associations between use of specific antibiotics and infection with an antibiotic-resistant-organism.
We conducted a systematic review of studies that investigated risk factors for extended-spectrum beta -lactamase (ESBL)-producing Escherichia coli and Klebsiella species to identify variability in past approaches to describing the extent of antibiotic use. We then reanalyzed a data set from a prior study of risk factors for infection with ESBL-producing E. coli and Klebsiella species. We developed 2 separate multivariable models: 1 in which prior antibiotic use was described as a categorical variable (eg, exposure or no exposure) and 1 in which antibiotic use was described as a continuous variable (eg, measured in antibiotic-days). These models were compared qualitatively.
Large academic medical center.
The 25 articles included in the systematic review revealed a variety of methods used to describe the extent of prior antibiotic exposure. Only 1 study justified its approach. Results from the 2 multivariable models that used different methodologic approaches differed substantially. Specifically, use of third-generation cephalosporins was a risk factor for infection with ESBL-producing E. coli and Klebsiella species when antibiotic use was described as a continuous variable but not when antibiotic use was described as a categorical variable.
There has been no consistent method for assessing the extent of prior antibiotic exposure. The use of different methods may substantially alter the identified antimicrobial risk factors, which has important implications for the resultant interventions regarding antimicrobial use.
许多研究调查了既往抗生素使用与抗生素耐药性之间的关联。然而，过去研究中用于描述既往抗生素使用程度的方法（例如，使用暴露与未暴露两类情况以及暴露持续时间的测量）尚未得到综述。使用不同方法量化抗生素使用的影响尚不清楚。本研究的目的是描述过去描述抗生素使用程度的方法，并确定使用不同方法对特定抗生素使用与抗生素耐药菌感染之间关联的影响。
我们对调查产超广谱β-内酰胺酶（ESBL）的大肠埃希菌和克雷伯菌属危险因素的研究进行了系统综述，以确定过去描述抗生素使用程度方法的变异性。然后，我们重新分析了先前一项关于产ESBL大肠埃希菌和克雷伯菌属感染危险因素研究的数据集。我们建立了2个独立的多变量模型：1个模型中既往抗生素使用被描述为分类变量（例如，暴露或未暴露），另1个模型中抗生素使用被描述为连续变量（例如，以抗生素使用天数衡量）。对这些模型进行了定性比较。
大型学术医疗中心。
系统综述纳入的25篇文章揭示了用于描述既往抗生素暴露程度的多种方法。只有1项研究说明了其方法的合理性。使用不同方法学方法的2个多变量模型的结果差异很大。具体而言，当抗生素使用被描述为连续变量时，使用第三代头孢菌素是产ESBL大肠埃希菌和克雷伯菌属感染的危险因素，但当抗生素使用被描述为分类变量时则不是。
评估既往抗生素暴露程度尚无一致的方法。使用不同方法可能会显著改变所确定的抗菌危险因素，这对由此产生的抗菌药物使用干预措施具有重要意义。
