Department of Epidemiology and Biostatics, Drexel University, Philadelphia, PA, USA.
Pediatr Infect Dis J. 2012 Apr;31(4):331-6. doi: 10.1097/INF.0b013e3182489cc4.
The aim of this study was to determine the influence of pneumococcal penicillin-nonsusceptibility patterns on individual antibiotic prescription among 33 children's hospitals using a multilevel, random- intercept, logistic regression analysis.
It was a multilevel cross-sectional study. The participants were children, 1-18 years of age, with community-acquired pneumonia (CAP) who were discharged in 2006. Hospital antibiotic susceptibility data were collected from surveys, and patient data were obtained from an administrative database. The primary exposure was the proportion of penicillin-nonsusceptible pneumococcal isolates reported in 2005 by each hospital. A secondary exposure included using the proportion of penicillin-resistant pneumococcal isolates to determine whether a threshold of susceptibility existed. Receipt of broad-spectrum empiric antibiotic therapy in 2006 (ie, antibiotics other than penicillins or aminopenicillins) was the main outcome measure.
Four thousand eight hundred eighty-eight children diagnosed with CAP were eligible. The proportion of penicillin-nonsusceptible isolates ranged from 9% to 70% across hospitals whereas the proportion of penicillin-resistant isolates ranged from 0% to 60%. Broad-spectrum antibiotics were prescribed to 93% of patients; 45% of patients received cephalosporin class antibiotics alone. There was no significant association between the proportion of pencillin-nonsusceptible pneumococcal isolates at individual hospitals and narrow-spectrum prescribing. However, every 10% increase in penicillin-resistant pneumococcal isolates was associated with a 39% increase in broad-spectrum antibiotic prescribing (adjusted odds ratio: 1.39; 95% confidence interval: 1.08-1.69).
There was substantial variability in empiric antibiotic prescribing for CAP among children's hospitals in the United States. High-levels (ie, resistant) but not modest-levels (ie, intermediate susceptibility) of penicillin resistance were associated with broad-spectrum antibiotic prescribing.
本研究旨在通过多水平、随机截距、逻辑回归分析，确定肺炎链球菌对青霉素不敏感模式对 33 家儿童医院个体抗生素处方的影响。
这是一项多水平的横断面研究。参与者为 2006 年出院的年龄在 1-18 岁的社区获得性肺炎（CAP）患儿。从调查中收集医院抗生素药敏数据，从管理数据库中获取患者数据。主要暴露因素为 2005 年每家医院报告的青霉素不敏感肺炎链球菌分离株比例。次要暴露因素包括使用青霉素耐药肺炎链球菌分离株的比例来确定是否存在耐药阈值。2006 年接受广谱经验性抗生素治疗（即除青霉素类或氨芐西林类以外的抗生素）是主要结局指标。
共有 4888 例符合条件的 CAP 患儿。各医院青霉素不敏感分离株的比例从 9%到 70%不等，而青霉素耐药分离株的比例从 0%到 60%不等。93%的患者使用了广谱抗生素；45%的患者单独使用头孢菌素类抗生素。个别医院青霉素不敏感肺炎链球菌分离株的比例与窄谱用药之间无显著关联。然而，青霉素耐药肺炎链球菌分离株每增加 10%，广谱抗生素的使用增加 39%（调整后的比值比：1.39；95%置信区间：1.08-1.69）。
美国儿童医院治疗儿童 CAP 的经验性抗生素使用存在很大差异。高水平（即耐药）而非适度水平（即中介敏感性）的青霉素耐药与广谱抗生素的使用有关。
