Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, BT9 7BL Belfast, Northern Ireland, UK.
Br J Clin Pharmacol. 2012 Jul;74(1):171-9. doi: 10.1111/j.1365-2125.2011.04161.x.
• The emergence and spread of bacteria producing extended-spectrum beta-lactamases (ESBLs) has important therapeutic and epidemiologic implications. • A key target for the establishment of hospital antibiotic stewardship is reducing the occurrence of additional antibiotic resistance. • Further research is needed to accumulate supporting evidence that reducing antibiotic use will result in a parallel reduction in antibiotic resistance.
• Fluoroquinolone restriction reversed ciprofloxacin resistance in primary and secondary healthcare settings. • Fluoroquinolone restriction reduced ESBL-producing bacteria incidence rates in both the primary and secondary healthcare settings. • This study highlights the value of time-series analysis in designing efficient antibiotic stewardship.
The objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates.
The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009).
Analysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P= 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P= 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P= 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P < 0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P= 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P < 0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates.
This study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship.
产生和传播能产生超广谱β-内酰胺酶（ESBL）的细菌具有重要的治疗和流行病学意义。
医院抗生素管理的一个关键目标是减少抗生素耐药性的发生。
需要进一步研究以积累支持证据，证明减少抗生素使用将导致抗生素耐药性的平行减少。
氟喹诺酮类药物的限制使初级和二级保健机构中的环丙沙星耐药性得到逆转。
氟喹诺酮类药物的限制降低了初级和二级保健机构中产生 ESBL 的细菌的发生率。
本研究强调了时间序列分析在设计高效抗生素管理中的价值。
本研究旨在研究医院抗生素使用、社区抗生素使用与医院产 ESBL 细菌发生率之间的关系，同时评估氟喹诺酮类药物限制政策对产 ESBL 细菌发生率的影响。
本研究为回顾性和生态学设计。建立了一个多变量自回归综合移动平均（ARIMA）模型，以在 5 年期间（2005 年 1 月至 2009 年 12 月）将抗生素使用与 ESBL 产生细菌的发生率和耐药模式联系起来。
分析表明，医院 ESBL 的发生率与医院氟喹诺酮类药物的使用（系数=0.174，P=0.02）、社区阿莫西林-克拉维酸（系数=1.03，P=0.03）和住院患者的平均合并症评分（系数=2.15，P=0.03）呈正相关，存在各种时间滞后。氟喹诺酮类药物限制政策成功实施，医院（主要是环丙沙星）氟喹诺酮类药物的平均使用量从 133 降至 17 个限定日剂量（DDD）/1000 个床位日（P<0.001），社区从 0.65 降至 0.54 DDD/1000 居民/天（P=0.0007）。这与两个环境中环丙沙星敏感性的改善有关[社区中从 16%提高到 28%（P<0.001）]，并与 ESBL 产生细菌发生率的统计学显著降低有关。
本研究支持限制某些抗菌类药物的使用以控制 ESBL 的价值，并证明了在成功的抗生素限制后逆转耐药模式的可行性。该研究还突出了时间序列分析在设计高效抗生素管理中的潜在价值。
