Kinoshita Takuya, Tokumasu Hironobu, Tanaka Shiro, Kramer Axel, Kawakami Koji
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany.
J Mark Access Health Policy. 2017 Jul 26;5(1):1351293. doi: 10.1080/20016689.2017.1351293. eCollection 2017.
: Policies to reduce methicillin-resistant (MRSA) infections, both healthcare-acquired (HA-MRSA) and livestock-associated (LA-MRSA) are implemented Europe-wide, but evaluations are difficult for countries yet to implement such policies. A descriptive study was conducted, describing multinational MRSA rates and policy implementation, focusing on MRSA mandatory surveillance. We also investigated antibiotic use and MRSA rates and the use of veterinary antibiotics. : This study used Europe-wide surveillance data on infectious diseases (EARS-Net), antibiotic consumption (ESAC-Net), and veterinary medicine (ESVAC). We visualized LA- and HA-MRSA related policies and MRSA rates from 1999 to 2015 in seven European countries. Changes in MRSA rates after implementation of an MRSA mandatory surveillance policy were investigated by setting each country as rate of 1.0 and compared countries with and without such policy. Correlations between antibiotic use and MRSA rates from 1999 to 2012 were investigated using defined daily dose. Sales data were used to investigate veterinary antibiotic use. : MRSA rates were 1-45.4% across the seven countries between 1999 and 2015. MRSA rates changed between 0.61 and 0.24 after the implementation of mandatory surveillance policies within a 6-12 year span. The rate of decrease rate in implemented and non-implemented countries ranged from 10% in Spain to 76% in the UK. The correlation between MRSA rate and cephalosporin consumption was = 0.419, and for fluoroquinolones = 0.305. Mean annual sales of veterinary cephalosporin and quinolone antibiotics were lowest in the UK (0.8 mg/PCU) and highest in Spain (9.7 mg/PCU) between 2009 and 2014. : There were similar but different health policy implications in the seven countries regarding LA- and HA-MRSA. Although causation could not be defined, some policies such as mandatory surveillance may be helpful for countries that have yet to implement an MRSA policy. Further investigations are needed to evaluate each policies.
在欧洲范围内实施了减少耐甲氧西林金黄色葡萄球菌（MRSA）感染的政策，包括医疗保健相关感染（HA-MRSA）和与牲畜相关的感染（LA-MRSA），但对于尚未实施此类政策的国家来说，评估工作存在困难。开展了一项描述性研究，描述跨国MRSA感染率和政策实施情况，重点关注MRSA强制监测。我们还调查了抗生素使用情况、MRSA感染率以及兽用抗生素的使用情况。
本研究使用了全欧洲范围内关于传染病（EARS-Net）、抗生素消费（ESAC-Net）和兽药（ESVAC）的监测数据。我们直观展示了1999年至2015年七个欧洲国家与LA-MRSA和HA-MRSA相关的政策及MRSA感染率。通过将每个国家的感染率设定为1.0，并比较有无MRSA强制监测政策的国家，研究了实施MRSA强制监测政策后MRSA感染率的变化。使用限定日剂量研究了1999年至2012年抗生素使用与MRSA感染率之间的相关性。利用销售数据调查兽用抗生素的使用情况。
1999年至2015年期间，七个国家的MRSA感染率在1%至45.4%之间。在6至12年的时间跨度内，实施强制监测政策后，MRSA感染率在0.61至0.24之间变化。实施和未实施该政策的国家中，感染率下降幅度从西班牙的10%到英国的76%不等。MRSA感染率与头孢菌素消费量之间的相关性为r = 0.419，与氟喹诺酮类药物的相关性为r = 0.305。2009年至2014年期间，英国兽用头孢菌素和喹诺酮类抗生素的年平均销售额最低（0.8毫克/每头畜单位），西班牙最高（9.7毫克/每头畜单位）。
七个国家在LA-MRSA和HA-MRSA方面有相似但不同的卫生政策含义。尽管无法确定因果关系，但一些政策，如强制监测，可能对尚未实施MRSA政策的国家有所帮助。需要进一步调查以评估各项政策。
