Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA.
Infect Control Hosp Epidemiol. 2012 Jun;33(6):594-601. doi: 10.1086/665724. Epub 2012 Apr 19.
To measure trends in aminoglycoside antibiotic use and gentamicin-resistant clinical isolates across a network of hospitals and compare network-level relationships with those of individual hospitals.
Longitudinal observational investigation.
US academic medical centers.
Adult inpatients.
Adult aminoglycoside use was measured from 2002 or 2003 through 2009 in 29 hospitals. Hospital-wide antibiograms assessed gentamicin resistance by proportions and incidence rates for Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Mixed-effects analysis of variance was used to assess the significance of changes in aminoglycoside use and changes in resistance rates and proportions. Generalized estimating equations were used to assess the relationship between aminoglycoside use and resistance.
Mean aminoglycoside use declined by 41%, reflecting reduced gentamicin (P < .0001) and tobramycin (P < .005) use; amikacin use did not change. The rate and proportion of gentamicin-resistant P. aeruginosa decreased by 48% (P < .0001) and 31% (P < .0001), respectively. The rate and proportion of gentamicin-resistant E. coli increased by 166% and 124%, respectively (P < .0001), and they were related to increasing quinolone resistance in E. coli. Resistance among K. pneumoniae and A. baumannii did not change. Relationships between aminoglycoside use and resistance at the network level were highly variable at the individual hospital level.
Mean aminoglycoside use declined in this network of US hospitals and was associated with significant and opposite changes in rates of resistance for some organisms and no change for others. At the individual hospital level, antibiograms appear to be an unreliable reflection of antibiotic use, at least for aminoglycosides.
测量氨基糖苷类抗生素的使用趋势和整个网络中庆大霉素耐药的临床分离株，并将网络水平的关系与个别医院的关系进行比较。
纵向观察性研究。
美国学术医疗中心。
成年住院患者。
29 家医院的成人氨基糖苷类药物使用量从 2002 年或 2003 年测量到 2009 年。全医院抗生素谱通过铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌的比例和发生率来评估庆大霉素耐药性。采用混合效应方差分析评估氨基糖苷类药物使用量和耐药率及耐药比例变化的显著性。采用广义估计方程评估氨基糖苷类药物使用量与耐药性之间的关系。
平均氨基糖苷类药物使用量下降了 41%，这反映了庆大霉素（P<0.0001）和妥布霉素（P<0.005）使用量的减少；阿米卡星的使用量没有变化。庆大霉素耐药铜绿假单胞菌的发生率和比例分别下降了 48%（P<0.0001）和 31%（P<0.0001）。庆大霉素耐药大肠埃希菌的发生率和比例分别增加了 166%和 124%（P<0.0001），且与大肠埃希菌中喹诺酮类耐药性的增加有关。肺炎克雷伯菌和鲍曼不动杆菌的耐药性没有变化。网络水平上氨基糖苷类药物使用与耐药性之间的关系在个体医院水平上差异很大。
在这个美国医院网络中，平均氨基糖苷类药物的使用量下降，与某些病原体的耐药率显著而相反的变化有关，而其他病原体则没有变化。在个体医院水平上，抗生素谱似乎不能可靠地反映抗生素的使用情况，至少对氨基糖苷类药物是这样。
