Department of Family and Occupational Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
BMC Infect Dis. 2019 Mar 13;19(1):253. doi: 10.1186/s12879-019-3889-3.
Antimicrobial resistance (AMR) is an increasing public health problem worldwide. We studied some patient-related factors that might influence the antimicrobial resistance. and whether the volume of antibiotic prescribing of the primary care physicians correlate with the antibiotic resistance rates of commensal nasal Staphylococcus aureus and Streptococcus pneumoniae.
The socio-demographic questionnaires, the antibiotic prescription and resistance data of commensal nasal S. aureus and S. pneumoniae were collected in the 20 participating Hungarian practices of the APRES study. Multivariate logistic regression analyses were performed on the patient-related data and the antimicrobial resistance of the S. aureus and S. pneumoniae on individual, patient level. Ecological analyses were performed with Spearman's rank correlations at practice level, the analyses were performed in the whole sample (all practices) and in the cohorts of primary care practices taking care of adults (adult practices) or children (paediatric practices).
According to the multivariate model, age of the patients significantly influenced the antimicrobial resistance of the S. aureus (OR = 0.42, p = 0.004) and S. pneumoniae (OR = 0.89, p < 0.001). Living with children significantly increased the AMR of the S. pneumoniae (OR = 1.23, p = 0.019). In the cohorts of adult or paediatric practices, neither the age nor other variables influenced the AMR of the S. aureus and S. pneumoniae. At practice level, the prescribed volume of penicillins significantly correlated with the resistance rates of the S. aureus isolates to penicillin (rho = 0.57, p = 0.008). The volume of prescribed macrolides, lincosamides showed positive significant correlations with the S. pneumoniae resistance rates to clarithromycin and/or clindamycin in all practices (rho = 0.76, p = 0.001) and in the adult practices (rho = 0.63, p = 0.021).
The age is an important influencing factor of antimicrobial resistance. The results also suggest that there may be an association between the antibiotic prescribing of the primary care providers and the antibiotic resistance of the commensal S. aureus and S. pneumoniae. The role of the primary care physicians in the appropriate antibiotic prescribing is very important to avoid the antibiotic resistance.
抗菌药物耐药性（AMR）是全球日益严重的公共卫生问题。我们研究了一些可能影响抗菌药物耐药性的患者相关因素，以及初级保健医生开具的抗生素量是否与共生鼻腔金黄色葡萄球菌和肺炎链球菌的抗生素耐药率相关。
在 APRES 研究的 20 个参与的匈牙利实践中，收集了社会人口学问卷、抗生素处方和共生鼻腔金黄色葡萄球菌和肺炎链球菌的耐药数据。对个体患者水平的患者相关数据和金黄色葡萄球菌和肺炎链球菌的抗菌药物耐药性进行了多变量逻辑回归分析。在实践水平上进行了生态分析，使用 Spearman 等级相关系数进行分析，分析在整个样本（所有实践）和照顾成人（成人实践）或儿童（儿科实践）的初级保健实践队列中进行。
根据多变量模型，患者的年龄显著影响金黄色葡萄球菌（OR=0.42，p=0.004）和肺炎链球菌（OR=0.89，p<0.001）的抗菌药物耐药性。与儿童同住会显著增加肺炎链球菌的 AMR（OR=1.23，p=0.019）。在成人或儿科实践队列中，年龄或其他变量均未影响金黄色葡萄球菌和肺炎链球菌的 AMR。在实践水平上，青霉素的处方量与金黄色葡萄球菌分离株对青霉素的耐药率显著相关（rho=0.57，p=0.008）。在所有实践（rho=0.76，p=0.001）和成人实践（rho=0.63，p=0.021）中，大环内酯类和林可酰胺类抗生素的处方量与肺炎链球菌对克拉霉素和/或克林霉素的耐药率呈正相关。
年龄是抗菌药物耐药性的一个重要影响因素。研究结果还表明，初级保健提供者的抗生素处方与共生金黄色葡萄球菌和肺炎链球菌的抗生素耐药性之间可能存在关联。初级保健医生在适当使用抗生素方面的作用非常重要，以避免抗生素耐药性的产生。
