Tacconelli Evelina, De Angelis Giulia, Cataldo Maria A, Pozzi Emanuela, Cauda Roberto
Department of Infectious Diseases, Catholic University, Rome, Italy.
J Antimicrob Chemother. 2008 Jan;61(1):26-38. doi: 10.1093/jac/dkm416. Epub 2007 Nov 6.
Current evidence does not provide a clear definition of the association between methicillin-resistant Staphylococcus aureus (MRSA) isolation and previous antibiotic use. A systematic review was performed to determine whether antibiotic exposure is a risk factor for the isolation of MRSA.
MEDLINE and EMBASE databases were searched to identify studies published between 1976 and 2007 on the role of antibiotics as a risk factor for MRSA isolation in adult patients. The outcome of interest was MRSA isolation. Summary statistics were risk ratios (RR) comparing MRSA-positive patients to those without S. aureus isolation or with methicillin-susceptible S. aureus isolation.
Seventy-six studies, including a total of 24 230 patients, met the inclusion criteria. Antibiotic exposure was determined in the 126 +/- 184 (mean +/- SD) days preceding MRSA isolation. The risk of acquiring MRSA was increased by 1.8-fold [95% confidence interval (CI), 1.7-1.9; P < 0.001] in patients who had taken antibiotics. The RR for single classes of antibiotics was 3 (95% CI, 2.5-3.5) for quinolones, 2.9 (95% CI, 2.4-3.5) for glycopeptides, 2.2 (95% CI, 1.7-2.9) for cephalosporins and 1.9 (95% CI, 1.7-2.2) for other beta-lactams. Significant heterogeneity was detected among studies. A regression analysis revealed that the heterogeneity was linked to the length of time in which antibiotic exposure was detected before MRSA isolation (more or less than 180 days).
This meta-analysis shows a clear association between exposure to antibiotics and MRSA isolation. This information may be useful for researchers in designing future studies and for policy decision-making on the appropriate management of antibiotic therapies.
目前的证据并未明确界定耐甲氧西林金黄色葡萄球菌（MRSA）分离与既往抗生素使用之间的关联。进行了一项系统评价，以确定抗生素暴露是否为MRSA分离的危险因素。
检索MEDLINE和EMBASE数据库，以识别1976年至2007年间发表的关于抗生素作为成年患者MRSA分离危险因素作用的研究。感兴趣的结局是MRSA分离。汇总统计数据为风险比（RR），比较MRSA阳性患者与未分离出金黄色葡萄球菌或分离出甲氧西林敏感金黄色葡萄球菌的患者。
76项研究，共纳入24230例患者，符合纳入标准。在MRSA分离前126±184（均值±标准差）天确定抗生素暴露情况。使用过抗生素的患者获得MRSA的风险增加了1.8倍[95%置信区间（CI），1.7 - 1.9；P < 0.001]。单类抗生素的RR值，喹诺酮类为3（95% CI，2.5 - 3.5），糖肽类为2.9（95% CI，2.4 - 3.5），头孢菌素类为2.2（95% CI，1.7 - 2.9），其他β-内酰胺类为1.9（95% CI，1.7 - 2.2）。研究间检测到显著异质性。回归分析显示，异质性与MRSA分离前检测到抗生素暴露的时间长短（大于或小于180天）有关。
这项荟萃分析表明抗生素暴露与MRSA分离之间存在明确关联。该信息可能有助于研究人员设计未来研究，并为抗生素治疗的适当管理提供政策决策依据。
