Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy-MUSC Campus, MSC 140, Charleston, SC 29425, USA.
Eur J Clin Microbiol Infect Dis. 2010 Sep;29(9):1125-9. doi: 10.1007/s10096-010-0972-5. Epub 2010 Jun 10.
Using susceptibility rates of Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae over time as markers, we assessed the significance of the change of susceptibility rates to imipenem, ceftriaxone, cefepime, piperacillin/tazobactam, and ciprofloxacin over time and the relationship to antibiotic use for the period 2000-2006. Antibiotic use-susceptibility relationships were assessed using longitudinal regression analysis. The variables "time" and define daily doses (DDD)/1,000 patient days for the specific drug related to the susceptibility rates of that particular model's dependent variable were considered as the main effects, with significance determined at the 0.05 level. Decreases in susceptibility of the target organisms were common over the period of observation. Decreasing susceptibility trends over time were not statistically associated with the primary drug (e.g., organism susceptibility rate to imipenem with imipenem usage). However, secondary drug use was associated with susceptibility rates (e.g., susceptibility of E. cloacae to cefepime with piperacillin/tazobactam usage). These results suggest that antibiotic use-resistance relationships are influenced by the use of secondary antibiotics. Thus, a resistance problem may not be adequately addressed by simply altering the utilization of the primary antibiotic.
我们以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌的药敏率随时间的变化为指标，评估了 2000 年至 2006 年期间，时间和特定药物的定义日剂量（DDD）/1000 患者日与药敏率的关系，以评估药敏率随时间的变化与抗生素使用之间的相关性。采用纵向回归分析评估抗生素使用-药敏关系。主要影响因素为“时间”和与特定模型的因变量药敏率相关的特定药物的 DDD/1000 患者日，显著水平为 0.05。在观察期间，目标生物体的药敏率普遍下降。随着时间的推移，药敏率的下降趋势与主要药物（如亚胺培南的使用与亚胺培南的药敏率）没有统计学关联。然而，二线药物的使用与药敏率有关（如哌拉西林/他唑巴坦的使用与阴沟肠杆菌对头孢吡肟的药敏率）。这些结果表明，抗生素使用-耐药关系受到二线抗生素使用的影响。因此，仅仅改变主要抗生素的使用可能无法充分解决耐药问题。
