Continuous Training Department, Centre for Legal Studies, Ministry of Justice, Madrid, Spain; Animal Health Department, Faculty of Veterinary Science, Complutense University, Madrid, Spain.
Faculty of Mathematics, Complutense University, Madrid, Spain.
Int J Antimicrob Agents. 2020 Jan;55(1):105800. doi: 10.1016/j.ijantimicag.2019.09.004. Epub 2019 Sep 12.
Infections with bacteria harbouring resistance to cephalosporins or fluoroquinolones (FQ) constitute a serious hazard to human health.
To establish a methodology based on econometric analysis and the largest European Union (EU) resistance database (EARS-Net), to model nosocomial antimicrobial resistance (AMR) in the EU and to detect tendency changes, steps or peaks. The contribution of legislation based on third-generation cephalosporin (3GC) and FQ class referrals to resistance rate patterns is evaluated.
Resistance to 3GC and FQ was examined in nosocomial Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa in at least 25 out of 30 EU countries (> 94% population coverage), weighted by their mean annual population, between 2006 and 2016. Autoregressive integrated moving average (ARIMA) model analysis, inspired by Box-Jenkins methodology, was prepared to adjust series to a mathematical model to detect hypothetical changes in the general behaviour. To the best of the authors' knowledge, this is the first study to use ARIMA with interventions to model overall nosocomial AMR data compiled in EARS-Net.
Econometric ARIMA models statistically prove the occurence of slowdowns and reversions in the increasing trend of AMR prevalence in nosocomial E. coli and K. pneumoniae to 3GC and FQ, as well as resistance of P. aeruginosa to 3GC. The resistance of P. aeruginosa to FQ exhibited a descending slope. The presented decreasing trends constitute noteworthy milestones in tackling AMR in Europe.
对头孢菌素或氟喹诺酮类药物（FQ）耐药的细菌感染对人类健康构成严重威胁。
建立一种基于计量经济学分析和最大的欧盟（EU）耐药数据库（EARS-Net）的方法，对欧盟医院获得性抗菌药物耐药性（AMR）进行建模，并检测趋势变化、步骤或峰值。评估基于第三代头孢菌素（3GC）和 FQ 类转介的立法对耐药率模式的贡献。
在 2006 年至 2016 年间，在至少 25 个欧盟国家（>94%的人口覆盖率）中，按其平均年人口加权，对至少 25 个欧盟国家（>94%的人口覆盖率）进行了医院获得性大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对 3GC 和 FQ 的耐药性检测。受 Box-Jenkins 方法启发，采用自回归综合移动平均（ARIMA）模型分析来调整序列以适应数学模型，以检测一般行为中的假设变化。据作者所知，这是首次使用 ARIMA 与干预措施来对 EARS-Net 中汇编的医院获得性 AMR 数据进行建模的研究。
计量经济学 ARIMA 模型从统计学上证明了医院获得性大肠埃希菌和肺炎克雷伯菌对 3GC 和 FQ 的耐药率以及铜绿假单胞菌对 3GC 的耐药率呈上升趋势的放缓和逆转。铜绿假单胞菌对 FQ 的耐药性呈下降趋势。所呈现的下降趋势是欧洲对抗 AMR 的重要里程碑。
