基层医疗中抗生素处方对个体患者抗菌药物耐药性的影响：系统评价和荟萃分析。

Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis.

机构信息

Academic Unit of Primary Health Care, NIHR National School for Primary Care Research, Department of Community Based Medicine, University of Bristol, Bristol BS8 2AA.

出版信息

BMJ. 2010 May 18;340:c2096. doi: 10.1136/bmj.c2096.

DOI:10.1136/bmj.c2096

PMID:20483949

Abstract

OBJECTIVE

To systematically review the literature and, where appropriate, meta-analyse studies investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Observational and experimental studies identified through Medline, Embase, and Cochrane searches. Review methods Electronic searches using MeSH terms and text words identified 4373 papers. Two independent reviewers assessed quality of eligible studies and extracted data. Meta-analyses were conducted for studies presenting similar outcomes.

RESULTS

The review included 24 studies; 22 involved patients with symptomatic infection and two involved healthy volunteers; 19 were observational studies (of which two were prospective) and five were randomised trials. In five studies of urinary tract bacteria (14 348 participants), the pooled odds ratio (OR) for resistance was 2.5 (95% confidence interval 2.1 to 2.9) within 2 months of antibiotic treatment and 1.33 (1.2 to 1.5) within 12 months. In seven studies of respiratory tract bacteria (2605 participants), pooled ORs were 2.4 (1.4 to 3.9) and 2.4 (1.3 to 4.5) for the same periods, respectively. Studies reporting the quantity of antibiotic prescribed found that longer duration and multiple courses were associated with higher rates of resistance. Studies comparing the potential for different antibiotics to induce resistance showed no consistent effects. Only one prospective study reported changes in resistance over a long period; pooled ORs fell from 12.2 (6.8 to 22.1) at 1 week to 6.1 (2.8 to 13.4) at 1 month, 3.6 (2.2 to 6.0) at 2 months, and 2.2 (1.3 to 3.6) at 6 months.

CONCLUSIONS

Individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic. The effect is greatest in the month immediately after treatment but may persist for up to 12 months. This effect not only increases the population carriage of organisms resistant to first line antibiotics, but also creates the conditions for increased use of second line antibiotics in the community.

摘要

目的

系统综述文献，并在适当情况下对初级保健中开具抗生素的个体后续抗生素耐药性进行荟萃分析研究。

设计

系统综述和荟萃分析。

资料来源

通过 Medline、Embase 和 Cochrane 检索确定的观察性和实验性研究。

检索方法

使用 MeSH 术语和文本词进行电子检索，共识别出 4373 篇论文。两名独立的审查员评估合格研究的质量并提取数据。对具有相似结局的研究进行荟萃分析。

结果

综述纳入了 24 项研究；22 项研究涉及有症状感染的患者，2 项研究涉及健康志愿者；19 项为观察性研究（其中 2 项为前瞻性研究），5 项为随机试验。在 5 项泌尿系统细菌研究（14348 名参与者）中，抗生素治疗后 2 个月内的耐药比值比（OR）为 2.5（95%置信区间 2.1 至 2.9），12 个月内为 1.33（1.2 至 1.5）。在 7 项呼吸道细菌研究（2605 名参与者）中，同期的汇总 OR 分别为 2.4（1.4 至 3.9）和 2.4（1.3 至 4.5）。报告抗生素使用量的研究发现，用药时间较长和疗程较多与耐药率升高有关。比较不同抗生素诱导耐药能力的研究未显示出一致的影响。仅有一项前瞻性研究报告了长期耐药变化情况；汇总 OR 从治疗后 1 周的 12.2（6.8 至 22.1）降至 1 个月的 6.1（2.8 至 13.4）、2 个月的 3.6（2.2 至 6.0）和 6 个月的 2.2（1.3 至 3.6）。