Clalit Health Services, Chief Physician's Office, Tel Aviv, Israel; School of Public Health, University of Haifa, Haifa, Israel.
Division of Infectious Diseases and Internal Medicine B, Rambam Healthcare Campus and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Lancet Infect Dis. 2019 Apr;19(4):419-428. doi: 10.1016/S1473-3099(18)30676-5. Epub 2019 Mar 4.
It is unknown whether increased use of antibiotics in a community increases the risk of acquiring antibiotic resistance by individuals living in that community, regardless of prior individual antibiotic consumption and other risk factors for antibiotic resistance.
We used a hierarchical multivariate logistic regression approach to evaluate the association between neighbourhood fluoroquinolone consumption and individual risk of colonisation or infection of the urinary tract with fluoroquinolone-resistant Escherichia coli. We did a population-based case-control study of adults (aged ≥22 years) living in 1733 predefined geographical statistical areas (neighbourhoods) in Israel. A multilevel study design was used to analyse data derived from electronic medical records of patients enrolled in the Clalit state-mandated health service.
300 105 events with E coli growth and 1 899 168 cultures with no growth were identified from medical records and included in the analysis. 45 427 (16·8%) of 270 190 women and 8835 (29·5%) of 29 915 men had fluoroquinolone-resistant E coli events. We found an independent association between residence in a neighbourhood with higher antibiotic consumption and an increased risk of bacteriuria caused by fluoroquinolone-resistant E coli. Odds ratios (ORs) for the quintiles with higher neighbourhood consumption (compared with the lowest quintile) were 1·15 (95% CI 1·06-1·24), 1·31 (1·20-1·43), 1·41 (1·29-1·54), and 1·51 (1·38-1·65) for women, and 1·17 (1·02-1·35), 1·24 (1·06-1·45), 1·35 (1·15-1·59), and 1·50 (1·26-1·77) for men. Results remained significant when the analysis was restricted to patients who had not consumed fluoroquinolones themselves.
These data suggest that increased use of antibiotics in specific geographical areas is associated with an increased personal risk of acquiring antibiotic-resistant bacteria, independent of personal history of antibiotic consumption and other known risk factors for antimicrobial resistance.
None.
目前尚不清楚社区内抗生素使用量的增加是否会增加居住在该社区的个体获得抗生素耐药性的风险，而不论其先前的个体抗生素使用情况和其他抗生素耐药性的危险因素如何。
我们使用分层多变量逻辑回归方法来评估社区氟喹诺酮类药物消费与个体尿路氟喹诺酮类耐药大肠杆菌定植或感染风险之间的关联。我们对居住在以色列 1733 个预先确定的地理统计区域（邻里）的成年人（年龄≥22 岁）进行了一项基于人群的病例对照研究。使用多水平研究设计分析了从纳入克拉利特州授权医疗服务的患者的电子病历中获得的数据。
从病历中确定了 300105 例大肠埃希菌生长事件和 1899168 例无生长培养物，并将其纳入分析。在 270190 名女性中，45427 名（16.8%）和 29915 名男性中有 8835 名（29.5%）有氟喹诺酮类耐药大肠埃希菌事件。我们发现，居住在抗生素消耗较高的邻里与氟喹诺酮类耐药大肠埃希菌引起的菌尿症风险增加之间存在独立关联。与最低五分位相比，五分位较高的邻里消费（五分位 1-5）的比值比（OR）分别为 1.15（95%CI 1.06-1.24）、1.31（1.20-1.43）、1.41（1.29-1.54）和 1.51（1.38-1.65），女性分别为 1.17（1.02-1.35）、1.24（1.06-1.45）、1.35（1.15-1.59）和 1.50（1.26-1.77），男性分别为 1.17（1.02-1.35）、1.24（1.06-1.45）、1.35（1.15-1.59）和 1.50（1.26-1.77）。当分析仅限于未使用过氟喹诺酮类药物的患者时，结果仍然显著。
这些数据表明，特定地理区域抗生素使用量的增加与个人获得抗生素耐药细菌的风险增加有关，而与个人抗生素使用史和其他已知的抗生素耐药性危险因素无关。
无。
