McGill University, Department of Family Medicine, Montreal, Quebec, Canada.
Pharmacoepidemiol Drug Saf. 2013 Sep;22(9):970-6. doi: 10.1002/pds.3461. Epub 2013 Jun 4.
Obesity, a major health issue, is also an important risk factor for infections. Evidence demonstrates that excess weight affects the disposition of antibiotics but little work has been done to explore if this results in antibiotic treatment failure (ATF). ATF has serious adverse health outcomes and may increase treatment resistance. Given that obese patients often have other health issues, it is important to determine if excess weight independently increases the likelihood of ATF.
Consenting patients (N = 18 014), randomly sampled from Santé Québec Health surveys (1992, 1998), were linked with administrative health databases. Patients were within the normal, overweight, and obese weight categories aged 20-79 years old, receiving at least one course of antibiotic therapy from the survey date until December 2005. ATF was defined as any additional antibiotic prescriptions or hospitalizations for infections within the 30 days after initial therapy. Logistic regression was used to assess the impact of excess weight on ATF after adjusting for patient characteristics, comorbidities, history of antibiotic use, antibiotic resistance, and flu season.
Of the final sample size (N = 6 179), 39.0% were overweight and 21.4% were obese. The most frequently prescribed antibiotics were amoxicillin (16.0%), ciprofloxacin (9.2%), phenoxymethylpenicillin (8.8%), trimethroprim/sulfamethoxazole (8.6%), and clarithromycin (8.5%). ATF occurred in 828 (13.4%) of the 6 179 study patients. Obesity was a significant predictor of ATF (adjusted OR 1.26; 95% CI 1.03-1.52).
Obesity is a significant risk factor for ATF, and this association may be due to the current "one size fits all" dosing strategy, which warrants further investigation.
肥胖是一个主要的健康问题，也是感染的一个重要危险因素。有证据表明，超重会影响抗生素的分布，但很少有研究探索这是否会导致抗生素治疗失败（ATF）。ATF 会带来严重的健康后果，并可能增加治疗耐药性。鉴于肥胖患者通常还有其他健康问题，因此确定超重是否会独立增加 ATF 的可能性非常重要。
从 Santé Québec 健康调查（1992 年、1998 年）中随机抽取同意参与的患者（N=18014），并将其与行政健康数据库相关联。患者年龄在 20-79 岁之间，体重处于正常、超重和肥胖类别，从调查日期开始至少接受了一个疗程的抗生素治疗，直到 2005 年 12 月。ATF 定义为初始治疗后 30 天内任何额外的抗生素处方或因感染住院。使用逻辑回归在调整患者特征、合并症、抗生素使用史、抗生素耐药性和流感季节后，评估超重对 ATF 的影响。
在最终样本量（N=6179）中，39.0%为超重，21.4%为肥胖。最常开的抗生素是阿莫西林（16.0%）、环丙沙星（9.2%）、苯氧甲基青霉素（8.8%）、甲氧苄啶/磺胺甲噁唑（8.6%）和克拉霉素（8.5%）。在 6179 名研究患者中，有 828 名（13.4%）发生了 ATF。肥胖是 ATF 的一个显著预测因素（调整后的 OR 1.26；95%CI 1.03-1.52）。
肥胖是 ATF 的一个重要危险因素，这种关联可能是由于目前“一刀切”的剂量策略所致，这值得进一步研究。
