Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Antimicrob Agents Chemother. 2010 Mar;54(3):1173-8. doi: 10.1128/AAC.01076-09. Epub 2010 Jan 11.
A surveillance study was performed in four Singapore public hospitals from 2006 to 2008 to determine the correlation between antibiotic prescription and Gram-negative bacterial antimicrobial resistance. Targeted organisms included ceftriaxone- and ciprofloxacin-resistant Escherichia coli and Klebsiella pneumoniae, as well as imipenem-resistant Pseudomonas aeruginosa and Acinetobacter spp. Antibiotic prescription data were collated in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days every quarter. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated via cross-correlation analysis. Results over 3 years indicated significantly rising incidence densities of ceftriaxone- and ciprofloxacin-resistant E. coli and imipenem-resistant Acinetobacter spp. (blood isolates only). Antimicrobial-resistant Klebsiella pneumoniae rates declined. The prescription rates of piperacillin-tazobactam, ertapenem, meropenem, ciprofloxacin, and levofloxacin increased significantly, while imipenem and moxifloxacin prescription decreased. Cross-correlation analysis demonstrated possible associations between prescription of fluoroquinolones and ciprofloxacin-resistant E. coli (R(2) = 0.46), fluoroquinolones and ceftriaxone-resistant E. coli (R(2) = 0.47), and carbapenems and imipenem-resistant Acinetobacter spp. (R(2) = 0.48), all at zero time lag. Changes in meropenem prescription were associated with a similar trend in imipenem-resistant Acinetobacter blood isolates after a 3-month time lag. No correlation was found between cephalosporin use and resistance. In conclusion, our data demonstrated correlation between prescription of and Gram-negative bacterial resistance to several, but not all, key antimicrobial agents in Singapore hospitals. In areas where Gram-negative bacterial resistance is endemic and prescription of broad-spectrum antimicrobial agents is high, factors other than antimicrobial usage may be equally important in maintaining high resistance rates.
一项监测研究于 2006 年至 2008 年在新加坡四家公立医院进行，旨在确定抗生素处方与革兰氏阴性细菌抗药性之间的相关性。目标生物体包括头孢曲松和环丙沙星耐药的大肠杆菌和肺炎克雷伯菌，以及亚胺培南耐药的铜绿假单胞菌和不动杆菌属。抗生素处方数据以世界卫生组织解剖治疗化学（ATC）/定义日剂量（DDD）格式整理，而抗生素耐药性则以每季度每住院日调整的发生率密度表示。通过线性回归确定个体趋势，通过交叉相关分析评估抗生素处方与耐药性之间的可能关联。三年的结果表明，头孢曲松和环丙沙星耐药的大肠杆菌和亚胺培南耐药的不动杆菌属（仅血液分离株）的发生率密度显著上升。抗微生物耐药的肺炎克雷伯菌率下降。哌拉西林他唑巴坦、厄他培南、美罗培南、环丙沙星和左氧氟沙星的处方率显著增加，而亚胺培南和莫西沙星的处方率下降。交叉相关分析表明，氟喹诺酮类药物和环丙沙星耐药的大肠杆菌（R(2) = 0.46）、氟喹诺酮类药物和头孢曲松耐药的大肠杆菌（R(2) = 0.47）以及碳青霉烯类药物和亚胺培南耐药的不动杆菌属之间可能存在关联，所有关联均为零时滞。美罗培南处方的变化与亚胺培南耐药的不动杆菌血液分离株在 3 个月时滞后的类似趋势相关。未发现头孢菌素使用与耐药性之间存在相关性。总之，我们的数据表明，新加坡医院的几种关键抗菌药物的处方与革兰氏阴性细菌耐药性之间存在相关性，但并非所有抗菌药物均存在相关性。在革兰氏阴性细菌耐药性流行且广谱抗菌药物处方较高的地区，除抗菌药物使用以外的其他因素可能同样重要，是维持高耐药率的原因。
