Université de Toulouse, Université Paul Sabatier, Unité de Pharmacoépidémiologie EA3696, Faculté de Médecine, Toulouse, France.
J Antimicrob Chemother. 2010 Dec;65(12):2650-7. doi: 10.1093/jac/dkq351. Epub 2010 Sep 27.
The increase in fluoroquinolone-resistant Escherichia coli has raised the issue of treatment failure in common infections. Few studies have investigated the possible relationship between outpatient fluoroquinolone consumption and resistance in hospital.
To investigate the relationship between inpatient and outpatient fluoroquinolone use and ciprofloxacin-resistant E. coli in a teaching hospital.
An ecological study was conducted in Toulouse University Hospital and its surrounding area, the Midi-Pyrénées region (south-western France), in 2004-07. Dynamic regression models were built to study how the hospital resistance rate was linearly related to current and past values of fluoroquinolone consumption. Resistance forecasts for 2008 were then calculated and compared with actual rates for the first 5 months of the year.
Mean resistance rate was 13.7% and mean fluoroquinolone use was 89.9 defined daily doses (DDDs)/1000 inpatient days in hospital and 2.6 DDDs/1000 inhabitants/day in the region. Taking into account past values of fluoroquinolone consumption in hospital and in outpatients, only levofloxacin use in the community remained significantly associated with resistance in hospital, with a lag of 12 months. This model explained 50% of the resistance variability.
This ecological analysis, conducted on a teaching hospital scale, suggests that ciprofloxacin resistance in E. coli in hospital is linked to consumption of fluoroquinolones within the hospital and its surrounding community. Among all fluoroquinolones, levofloxacin use was found to be the most important factor. Consumption in outpatients appears to be a relevant determinant to consider in designing interventions to reduce resistance in hospitals.
氟喹诺酮类药物耐药的大肠杆菌增加了常见感染治疗失败的问题。很少有研究调查医院门诊氟喹诺酮类药物消耗与耐药性之间的可能关系。
研究教学医院中住院和门诊氟喹诺酮类药物使用与环丙沙星耐药大肠杆菌之间的关系。
2004-07 年，在图卢兹大学医院及其周边地区（法国西南部米迪-比利牛斯地区）进行了一项生态学研究。建立动态回归模型，研究医院耐药率与氟喹诺酮类药物消耗的当前和过去值之间的线性关系。然后计算 2008 年的耐药预测值，并将其与当年前 5 个月的实际耐药率进行比较。
平均耐药率为 13.7%，氟喹诺酮类药物使用量为 89.9 定义日剂量（DDD）/1000 住院日，地区内 2.6 DDD/1000 居民/天。考虑到医院和门诊氟喹诺酮类药物消耗的过去值，只有社区左氧氟沙星的使用与医院的耐药性仍呈显著相关，滞后时间为 12 个月。该模型解释了 50%的耐药性变异性。
这项在教学医院规模上进行的生态学分析表明，医院大肠杆菌中环丙沙星耐药性与医院内及其周边社区氟喹诺酮类药物的消耗有关。在所有氟喹诺酮类药物中，左氧氟沙星的使用是最重要的因素。在设计减少医院耐药性的干预措施时，应考虑到门诊患者的用药情况。
