Gottesman Bat Sheva, Carmeli Yehuda, Shitrit Pnina, Chowers Michal
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel.
Clin Infect Dis. 2009 Sep 15;49(6):869-75. doi: 10.1086/605530.
Decreased antimicrobial susceptibility after increased antibiotic use is a known phenomenon. Restoration of susceptibility once antimicrobial use is decreased is not self-evident. Our objective was to evaluate, in a community setting, the impact of quinolone restriction on the antimicrobial resistance of E. coli urine isolates.
We conducted a retrospective, quasi-experimental ecological study to assess the proportion of quinolone-susceptible E. coli urine isolates in the periods before, during, and after a nationwide restriction on ciprofloxacin use was implemented. We used an interrupted time interval analysis for outcome evaluation.
We found a significant decline in quinolone consumption, measured as defined daily doses (DDDs) per month, between the preintervention and intervention periods (point estimate, -1827.3 DDDs per month; 95% confidence interval [CI], -2248.8 to -1405.9 DDDs per month; p < .001). This decline resulted in a significant decrease in E. coli nonsusceptibility to quinolones, from a mean of 12% in the preintervention period to a mean of 9% in the intervention period (odds ratio, 1.35; p = .014). The improved susceptibility pattern reversed immediately when quinolone consumption rose. Moreover, a highly significant inverse relationship was found between the level of quinolone use (regardless of intervention period) and the susceptibility of E. coli urine isolates to quinolone (odds ratio, 1.70; 95% CI, 1.26-2.28). During the months of highest quinolone use (8321 DDDs per month), the proportion of nonsusceptibility was 14%, whereas during the months of lowest quinolone use (4027 DDDs per month), the proportion of nonsusceptibility was 9%. An average decrease in resistance of 1.16% was observed for each decrease of 1000 DDDs.
Reducing quinolone consumption can lead to an immediate increase in the susceptibility of E. coli urine isolates to quinolones.
抗生素使用增加后抗菌药物敏感性降低是一种已知现象。抗菌药物使用减少后敏感性的恢复并非显而易见。我们的目的是在社区环境中评估喹诺酮类药物限制对大肠杆菌尿液分离株抗菌药物耐药性的影响。
我们进行了一项回顾性、准实验性生态学研究，以评估在全国范围内实施环丙沙星使用限制之前、期间和之后，对喹诺酮敏感的大肠杆菌尿液分离株的比例。我们使用间断时间序列分析进行结果评估。
我们发现，在干预前和干预期之间，以每月限定日剂量（DDD）衡量的喹诺酮类药物消费量显著下降（点估计值为每月-1827.3 DDD；95%置信区间[CI]为-2248.8至-1405.9 DDD/月；p<.001）。这种下降导致大肠杆菌对喹诺酮类药物的不敏感性显著降低，从干预前期的平均12%降至干预期的平均9%（优势比为1.35；p = 0.014）。当喹诺酮类药物消费量上升时，改善的敏感性模式立即逆转。此外，发现喹诺酮类药物使用水平（无论干预期如何）与大肠杆菌尿液分离株对喹诺酮类药物的敏感性之间存在高度显著的负相关（优势比为1.70；95%CI为1.26 - 2.28）。在喹诺酮类药物使用量最高的月份（每月8321 DDD），不敏感性比例为14%，而在喹诺酮类药物使用量最低的月份（每月4027 DDD），不敏感性比例为9%。每减少1000 DDD，耐药性平均下降1.16%。
减少喹诺酮类药物消费量可导致大肠杆菌尿液分离株对喹诺酮类药物的敏感性立即增加。
