Infectious Diseases Intervention Unit (U2i), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.
J Antimicrob Chemother. 2012 Apr;67(4):1010-5. doi: 10.1093/jac/dkr555. Epub 2012 Jan 11.
High rates of methicillin-resistant Staphylococcus aureus (MRSA) and fluoroquinolone-resistant Pseudomonas aeruginosa may be related, in part, to the overuse of fluoroquinolones. The objective was to analyse and correlate long-term surveillance data on MRSA and fluoroquinolone-resistant P. aeruginosa rates and antibiotic consumption after implementation of an institution-wide programme to reduce fluoroquinolone use.
An interrupted time series/quasi-experimental study of monthly fluoroquinolone use and MRSA and fluoroquinolone-resistant P. aeruginosa isolation rates was carried out in a tertiary hospital during three periods: pre-intervention (January 2000-August 2005), intervention (September 2005-March 2006), and post-intervention (March 2006-March 2010). The effect of the intervention on the consumption of fluoroquinolones and bacterial resistance was assessed using segmented regression analyses.
Mean monthly fluoroquinolone consumption dropped by 29.1 defined daily doses per 1000 patient-days (DDD/1000 PD) (95% CI 13.1-45.9; P = 0.0005) from a mean of 148.2 to 119.1 DDD/1000 PD during the intervention period. A sustained and significant decrease in fluoroquinolone consumption of -0.95 DDD/1000 PD/month was also observed during the post-intervention period (P = 0.0002). During the post-intervention period the rate of fluoroquinolone-resistant P. aeruginosa continuously decreased, from a mean of 42% to 26%, with a constant relative change rate of -13%/year (95% CI -19 to -5, P = 0.001). A decrease in the MRSA rate was observed during the intervention period, from a mean resistance rate of 27% to 21% (P < 0.0001).
We showed the sustained impact of a fluoroquinolone control programme on the reduction of fluoroquinolone use with a significant decrease in fluoroquinolone-resistant P. aeruginosa and MRSA rates over 4 years.
耐甲氧西林金黄色葡萄球菌（MRSA）和氟喹诺酮类耐药铜绿假单胞菌的高发生率可能部分与氟喹诺酮类药物的过度使用有关。本研究旨在分析和比较在实施一项减少氟喹诺酮类药物使用的全院性计划后，MRSA 和氟喹诺酮类耐药铜绿假单胞菌发生率和抗生素使用的长期监测数据。
在一家三级医院进行了一项关于氟喹诺酮类药物使用和 MRSA 及氟喹诺酮类耐药铜绿假单胞菌分离率的时间序列/准实验研究，该研究分为三个时期：干预前（2000 年 1 月至 2005 年 8 月）、干预期（2005 年 9 月至 2006 年 3 月）和干预后（2006 年 3 月至 2010 年 3 月）。采用分段回归分析评估干预措施对氟喹诺酮类药物消耗和细菌耐药性的影响。
平均每月氟喹诺酮类药物的使用量从干预前的 148.2 个 DDD/1000 PD 下降到 119.1 个 DDD/1000 PD（95%CI 13.1-45.9；P=0.0005），降幅为 29.1 个 DDD/1000 PD（95%CI 13.1-45.9；P=0.0005）。在干预后期间，还观察到氟喹诺酮类药物使用量持续减少，每月减少 0.95 DDD/1000 PD（P=0.0002）。在干预后期间，氟喹诺酮类耐药铜绿假单胞菌的发生率持续下降，从平均 42%降至 26%，年相对变化率为-13%/年（95%CI -19 至 -5，P=0.001）。在干预期间，MRSA 率也有所下降，从平均 27%降至 21%（P<0.0001）。
我们表明，氟喹诺酮类药物控制计划对减少氟喹诺酮类药物使用具有持续影响，在 4 年内显著降低了氟喹诺酮类耐药铜绿假单胞菌和 MRSA 的发生率。
