From the Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia.
Department of Paediatrics.
Pediatr Infect Dis J. 2020 May;39(5):397-405. doi: 10.1097/INF.0000000000002532.
In addition to health care settings, antibiotic resistance has also been increasing in the community. Healthy children represent an important potential reservoir of antibiotic-resistant (AR) bacteria. However, strategies to reduce the spread of AR bacteria often fail to specifically address the factors that promote the carriage of AR bacteria in this population.The objective of this review was to Identify risk factors for carriage of AR bacteria by healthy children.
We did a systematic search of MEDLINE, Embase and PubMed for studies in developed (OECD) countries that assessed risk factors for carriage of AR bacteria in healthy children in the community. We excluded studies done before 1998 and studies of AR Streptococcus pneumoniae carriage in the absence of pneumococcal conjugate vaccination.
Of 1234 studies identified, 30 were eligible for inclusion. These studies assessed the impact of 49 risk factors on AR strains of S. pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes and Escherichia coli. The majority of these risk factors were assessed in 2 or fewer studies per bacteria. Recent antibiotic consumption was associated with carriage of resistant respiratory bacteria (S. pneumoniae, H. influenzae); however, it was not consistently associated with carriage of AR bacteria in skin or stool (S. aureus and E. coli). For AR S. aureus, transmission within households appeared to have a greater impact than individual antibiotic use.
The factors that promote carriage of AR bacteria by healthy children differed between bacterial species. To reduce reservoirs of AR bacteria in the community, it is essential for intervention strategies to target the specific risk factors for different bacteria.
除了医疗保健环境外，社区中的抗生素耐药性也在不断增加。健康儿童是抗生素耐药（AR）细菌的重要潜在储主。然而，减少 AR 细菌传播的策略往往未能专门针对促进该人群携带 AR 细菌的因素。本综述的目的是确定健康儿童携带 AR 细菌的风险因素。
我们对 MEDLINE、Embase 和 PubMed 进行了系统检索，以确定评估社区中健康儿童携带 AR 细菌的风险因素的发达国家（经合组织）的研究。我们排除了 1998 年以前进行的研究以及在没有肺炎球菌结合疫苗的情况下评估 AR 肺炎链球菌携带的研究。
在确定的 1234 项研究中，有 30 项符合纳入标准。这些研究评估了 49 个风险因素对社区中健康儿童携带的 AR 肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、化脓性链球菌和大肠杆菌的影响。这些风险因素中的大多数在每个细菌中评估了 2 个或更少的研究。最近使用抗生素与耐药呼吸道细菌（肺炎链球菌、流感嗜血杆菌）的携带有关；然而，它与皮肤或粪便中 AR 细菌的携带并不一致（金黄色葡萄球菌和大肠杆菌）。对于 AR 金黄色葡萄球菌，家庭内传播的影响似乎大于个体抗生素的使用。
促进健康儿童携带 AR 细菌的因素因细菌种类而异。为了减少社区中 AR 细菌的储主，干预策略必须针对不同细菌的特定风险因素。
