Department of Pharmacology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
PLoS One. 2013 May 30;8(5):e65621. doi: 10.1371/journal.pone.0065621. Print 2013.
Better depicting the relationship between antibiotic consumption and evolutionary healthcare-associated infections (HAIs) caused by multidrug-resistant Gram-negative bacilli (MDR-GNB) may help highlight the importance of antibiotic stewardship.
METHODOLOGY/PRINCIPAL FINDINGS: The correlations between antibiotic consumption and MDR-GNB HAIs at a 2,700-bed primary care and tertiary referral center in Taiwan between 2002 and 2009 were assessed. MDR-GNB HAI referred to a HAI caused by MDR-Enterobacteriaceae, MDR-Pseudomonas aeruginosa or MDR-Acinetobacter spp. Consumptions of individual antibiotics and MDR-GNB HAI series were first evaluated for trend over time. When a trend was significant, the presence or absence of associations between the selected clinically meaningful antibiotic resistance and antibiotic consumption was further explored using cross-correlation analyses. Significant major findings included (i) increased consumptions of extended-spectrum cephalosporins, carbapenems, aminopenicillins/β-lactamase inhibitors, piperacillin/tazobactam, and fluoroquinolones, (ii) decreased consumptions of non-extended-spectrum cephalosporins, natural penicillins, aminopenicillins, ureidopenicillin and aminoglycosides, and (iii) decreasing trend in the incidence of the overall HAIs, stable trends in GNB HAIs and MDR-GNB HAIs throughout the study period, and increasing trend in HAIs caused by carbapenem-resistant (CR) Acinetobacter spp. since 2006. HAIs due to CR-Acinetobacter spp. was found to positively correlate with the consumptions of carbapenems, extended-spectrum cephalosporins, aminopenicillins/β-lactamase inhibitors, piperacillin/tazobactam and fluoroquinolones, and negatively correlate with the consumptions of non-extended-spectrum cephalosporins, penicillins and aminoglycosides. No significant association was found between the increased use of piperacilllin/tazobactam and increasing HAIs due to CR-Acinetobacter spp.
The trend in overall HAIs decreased and trends in GNB HAIs and MDR-GNB HAIs remained stable over time suggesting that the infection control practice was effective during the study period, and the escalating HAIs due to CR- Acinetobacter spp. were driven by consumptions of broad-spectrum antibiotics other than piperacillin/tazobactam. Our data underscore the importance of antibiotic stewardship in the improvement of the trend of HAIs caused by Acinetobacter spp.
更好地描述抗生素消耗与耐多药革兰氏阴性杆菌（MDR-GNB）引起的进化性医疗保健相关感染（HAIs）之间的关系，可能有助于突出抗生素管理的重要性。
方法/主要发现：在台湾的一家 2700 张床位的初级保健和三级转诊中心，评估了 2002 年至 2009 年间抗生素消耗与 MDR-GNB HAI 之间的相关性。MDR-GNB HAI 是指由 MDR-肠杆菌科、MDR-铜绿假单胞菌或 MDR-不动杆菌属引起的 HAI。首先评估了个体抗生素消耗和 MDR-GNB HAI 系列随时间的趋势。当趋势显著时，使用交叉相关分析进一步探讨了所选具有临床意义的抗生素耐药性与抗生素消耗之间是否存在关联。显著的主要发现包括：（i） 头孢菌素类、碳青霉烯类、氨青霉素/β-内酰胺酶抑制剂、哌拉西林/他唑巴坦和氟喹诺酮类的消耗增加，（ii） 非头孢菌素类、天然青霉素类、氨青霉素类、脲基青霉素类和氨基糖苷类的消耗减少，（iii） 总体 HAI 发病率呈下降趋势，整个研究期间 GNB HAI 和 MDR-GNB HAI 趋势稳定，自 2006 年以来碳青霉烯类耐药（CR）不动杆菌属引起的 HAI 呈上升趋势。发现 CR-不动杆菌属引起的 HAI 与碳青霉烯类、头孢菌素类、氨青霉素/β-内酰胺酶抑制剂、哌拉西林/他唑巴坦和氟喹诺酮类的消耗呈正相关，与非头孢菌素类、青霉素类和氨基糖苷类的消耗呈负相关。哌拉西林/他唑巴坦使用增加与 CR-不动杆菌属引起的 HAI 增加之间没有发现显著关联。
总体 HAI 呈下降趋势，GNB HAI 和 MDR-GNB HAI 呈稳定趋势，这表明研究期间感染控制实践是有效的，而 CR-不动杆菌属引起的不断升级的 HAI 是由除哌拉西林/他唑巴坦以外的广谱抗生素消耗驱动的。我们的数据强调了抗生素管理在改善不动杆菌属引起的 HAI 趋势方面的重要性。
