British Columbia Centre for Disease Control; ; School of Population and Public Health, University of British Columbia, Vancouver;
British Columbia Centre for Disease Control;
Can J Infect Dis Med Microbiol. 2015 Jan-Feb;26(1):33-8. doi: 10.1155/2015/274298.
Drug resistance indexes (DRIs) quantify the cumulative impact of antimicrobial resistance on the likelihood that a given pathogen will be susceptible to antimicrobial therapy.
To derive a DRI for community urinary tract infections caused by Escherichia coli in British Columbia for the years 2007 to 2010, and to examine trends over time and across patient characteristics.
Indication-specific utilization data were obtained from BC PharmaNet for outpatient antimicrobial prescriptions linked to diagnostic information from physician payment files. Resistance data for E coli urinary isolates were obtained from BC Biomedical Laboratories (now part of LifeLabs Medical Laboratory Services). DRIs were derived by multiplying the rate of resistance to a specific antimicrobial by the proportional rate of utilization for that drug class and aggregating across drug classes. Higher index values indicate more resistance.
Adaptive-use DRIs remained stable over time at approximately 18% (95% CI 17% to 18%) among adults ≥15 years of age and approximately 28% (95% CI 26% to 31%) among children <15 years of age. Similar results were observed when proportional drug use was restricted to the baseline year (ie, a static-use model). Trends according to age group suggest a U-shaped distribution, with the highest DRIs occurring among children <10 years of age and adults ≥65 years of age. Males had consistently higher DRIs than females for all age groups.
The stable trend in adaptive-use DRIs over time suggests that clinicians are adapting their prescribing practices for urinary tract infections to local resistance patterns. Results according to age group reveal a higher probability of resistance to initial therapy among young children and elderly individuals.
耐药指数（DRI）量化了抗菌药物耐药性对特定病原体对抗菌治疗敏感性的累积影响。
为 2007 年至 2010 年不列颠哥伦比亚省（BC）由大肠埃希菌引起的社区尿路感染制定 DRI，并考察随时间和患者特征的变化趋势。
从 BC PharmaNet 获取与医生支付文件中的诊断信息相关的门诊抗菌药物处方的指征特异性利用数据。从 BC 生物医学实验室（现为 LifeLabs 医学实验室服务公司的一部分）获取大肠埃希菌尿分离株的耐药数据。通过将特定抗菌药物的耐药率乘以该药物类别利用的比例，并对不同药物类别进行汇总，计算出 DRI。指数值越高，耐药性越强。
适应性 DRI 在≥15 岁的成年患者中保持稳定，大约为 18%（95%CI 17%至 18%），在<15 岁的儿童中大约为 28%（95%CI 26%至 31%）。当将药物的比例利用限制在基线年时（即静态利用模型），也观察到类似的结果。按年龄组的趋势表明存在 U 型分布，耐药性最高的发生在<10 岁的儿童和≥65 岁的成年人中。所有年龄组的男性 DRI 均高于女性。
随着时间的推移，适应性 DRI 的稳定趋势表明临床医生正在根据当地耐药模式调整尿路感染的处方实践。根据年龄组的结果显示，在年幼和年老的个体中，初始治疗的耐药性更高。
