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抗生素轮替政策对二级医疗机构中医疗相关性耐甲氧西林金黄色葡萄球菌和艰难梭菌感染发生率的影响。

Effects of Antibiotic Cycling Policy on Incidence of Healthcare-Associated MRSA and Clostridioides difficile Infection in Secondary Healthcare Settings.

出版信息

Emerg Infect Dis. 2019 Jan;25(1):52-62. doi: 10.3201/eid2501.180111.

DOI:10.3201/eid2501.180111
PMID:30561306
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6302607/
Abstract

This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.

摘要

本准实验研究通过时间序列分析流行病学数据，调查了基于抗生素轮替政策的效果，该政策确定了限制使用的抗菌药物和时间段。在干预医院，在 2 年期间周期性限制使用阿莫西林/克拉维酸、哌拉西林/他唑巴坦和克拉霉素。我们使用分段回归分析比较了该政策对医院获得性艰难梭菌感染（HA-CDI）、医院获得性耐甲氧西林金黄色葡萄球菌（HA-MRSA）和新的扩展谱β-内酰胺酶（ESBL）分离株发生率的影响，以及干预和对照医院之间 HA-MRSA 和 ESBL 分离株耐药模式的变化。HA-CDI 的发生率没有变化。HA-MRSA 的发生率在干预医院显著增加。新的 ESBL 分离株对阿莫西林/克拉维酸和哌拉西林/他唑巴坦的耐药性在干预医院显著下降；然而，在恢复标准政策后，哌拉西林/他唑巴坦的耐药性增加。研究结果对将抗生素轮替作为抗生素管理的价值提出了质疑。

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