Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA.
Infect Control Hosp Epidemiol. 2010 May;31(5):485-90. doi: 10.1086/652154.
Ertapenem exposure has been reported to select for cross-resistance to other carbapenems in Pseudomonas aeruginosa in vitro. Single-center investigations report conflicting results. We evaluated ertapenem use and antipseudomonal carbapenem susceptibility for 6 years spanning the time of ertapenem adoption at each of 25 US hospitals.
Retrospective primary and secondary data analysis.
Use density ratios for imipenem and meropenem (collectively, "other carbapenems") and ertapenem were derived from data in a commercial database on the total number of grams used in the 3 years before and the 3 years after adoption of ertapenem at each hospital. A general linear model using repeated measures analysis of variance was used to explore associations between the 6-year change in antipseudomonal carbapenem susceptibility rates (determined from hospital antibiograms) and ertapenem use in each year, while controlling for other carbapenem use.
Ertapenem use increased once adopted. With regard to the postadoption period, the median use density ratio for year 4 was 4.1 (interquartile range [IQR], 1.7-5.2), for year 5 was 6.0 (IQR, 2.7-8.5), and for year 6 was 6.5 (IQR, 4.0-11.6). The median use density ratio for other carbapenem use for year 1 was 8.7 (IQR, 5.7-13.5), and by year 6 it had increased to 19.3 (IQR, 9.6-26.2). Change in mean antipseudomonal carbapenem susceptibility across time (85% in year 1 to 82% in year 6) was not significant (P = .22). Change in 6-year antipseudomonal carbapenem susceptibility was not associated with ertapenem use in any year while controlling for other carbapenem use (P > .20 for all years of ertapenem use).
Although significant change in P. aeruginosa susceptibility to antipseudomonal carbapenems was not detected during this multicenter study, which to our knowledge is the most extensive assessment to date of this important drug use-susceptibility relationship, continued evaluation of the relationship is prudent.
已有研究报道，在体外，美罗培南和亚胺培南（统称“其他碳青霉烯类”）对铜绿假单胞菌的暴露会导致交叉耐药。单中心的研究结果却存在差异。我们评估了 25 家美国医院在采用厄他培南前后 6 年的厄他培南使用情况和抗假单胞菌碳青霉烯类药物的敏感性。
回顾性的原始数据和次级数据分析。
从商业数据库中获取每家医院在采用厄他培前后 3 年中，厄他培南和其他碳青霉烯类药物的总使用量，得出使用密度比。采用重复测量方差分析的一般线性模型来研究 6 年来抗假单胞菌碳青霉烯类药物敏感性（根据医院药敏试验确定）的变化与每年厄他培南使用量之间的相关性，同时控制其他碳青霉烯类药物的使用。
一旦采用厄他培南，其使用量便会增加。在采用厄他培南后的时期，第 4 年的中位使用密度比为 4.1（四分位距[IQR]，1.7-5.2），第 5 年为 6.0（IQR，2.7-8.5），第 6 年为 6.5（IQR，4.0-11.6）。第 1 年其他碳青霉烯类药物使用的中位使用密度比为 8.7（IQR，5.7-13.5），到第 6 年增加到 19.3（IQR，9.6-26.2）。在整个时间范围内，平均抗假单胞菌碳青霉烯类药物敏感性的变化（第 1 年为 85%，第 6 年为 82%）没有统计学意义（P =.22）。在控制其他碳青霉烯类药物使用的情况下，厄他培南使用量在任何一年的变化都与 6 年的抗假单胞菌碳青霉烯类药物敏感性变化无关（所有厄他培南使用年的 P 值均大于.20）。
尽管在这项多中心研究中未发现铜绿假单胞菌对抗假单胞菌碳青霉烯类药物敏感性的显著变化，但这是迄今为止对这种重要药物使用-敏感性关系的最广泛评估，继续评估这种关系是谨慎的。
