Healthcare-associated infections & Antimicrobial resistance (https://www.nsih.be), Sciensano, Ruy Juliette Wytsmanstraat 14, Brussels, 1050 Belgium.
2Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.
Antimicrob Resist Infect Control. 2018 Jun 18;7:76. doi: 10.1186/s13756-018-0368-3. eCollection 2018.
Treatment duration, treatment interval, formulation and type of antimicrobial (antibiotic) are modifiable factors that will influence antimicrobial selection pressure. Currently, the impact of the route of administration on the occurrence of resistance in humans is unclear.
In this retrospective multi-center cohort study, we assessed the impact of different variables on antimicrobial resistance (AMR) in pathogens isolated from the urinary tract in older adults. A generalized estimating equations (GEE) model was constructed using 7397 () isolates.
Resistance in was higher when more antibiotics had been prescribed before isolation of the sample, especially in women (significant interaction = 0.0016) and up to nine preceding prescriptions it was lower for higher proportions of preceding parenteral prescriptions (significant interactions = 0.0067). The laboratory identity, dying, and the time between prescription and sampling were important confounders ( < 0.001).
Our model describing shows a dose-response relation between antibiotic use and AMR in isolated from urine samples of older adults, and, for the first time, that higher proportions of preceding parenteral prescriptions are significantly associated with lower probabilities of AMR, provided that the number of preceding prescriptions is not extremely high (≥10 during the 1.5 year observation period; 93% of 5650 included patients).
Retrospectively registered.
治疗持续时间、治疗间隔、抗菌药物（抗生素）的剂型和类型是可改变的因素，这些因素将影响抗菌药物选择压力。目前，给药途径对人类耐药性发生的影响尚不清楚。
在这项回顾性多中心队列研究中，我们评估了不同变量对老年人尿源分离病原体的抗菌药物耐药性（AMR）的影响。使用广义估计方程（GEE）模型对 7397 个 () 分离株进行了分析。
在分离样本前使用的抗生素种类越多， 耐药性越高，尤其是女性（显著交互作用 = 0.0016），而在之前使用的注射用抗生素比例较高时，耐药性较低（显著交互作用 = 0.0067）。实验室身份、死亡以及处方和采样之间的时间也是重要的混杂因素（ < 0.001）。
我们的模型描述了抗生素使用与老年人尿液样本中分离的 耐药性之间的剂量反应关系，并且首次表明，在处方数量不是极高（在 1.5 年观察期内≥10 次；在纳入的 5650 名患者中，有 93%）的情况下，之前使用的注射用抗生素比例较高与 AMR 的可能性降低显著相关。
回顾性注册。
