School of Public Health and Community Medicine, UNSW Sydney, Sydney, Australia.
National Center for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.
Microb Drug Resist. 2020 Dec;26(12):1482-1490. doi: 10.1089/mdr.2020.0017. Epub 2020 Apr 21.
Antibiotics are not the recommended treatment for uncomplicated influenza or nontyphoidal salmonella infections, whereas they are for current pertussis infection. We investigated adherence to these recommendations in a population of older community-dwelling adults. Population-based prospective cohort study of Australian adults 45 years of age and older followed by record-linkage to laboratory-confirmed influenza, pertussis, and nontyphoidal salmonella notifications, hospitalization records, and antibiotic dispensing data from January 1, 2009 to December 31, 2015. Proportions of those with infections who were prescribed antibiotics were estimated, and characteristics associated with antibiotic prescribing were examined. There were 1,056 influenza, 151 pertussis, and 334 nontyphoidal salmonella cases in the cohort eligible for analysis. Antibiotics were dispensed in 56.2% (594/1,056) of influenza, 78.8% (119/151) of pertussis, and 39.5% (132/334) of nontyphoidal salmonella cases within the ±10-day window around the infection onset date. The likelihood of antibiotic dispensing did not differ according to most participant characteristics examined, including whether cases had an associated hospitalization, their age, and recorded comorbidities. Macrolides were the predominant class of antibiotics dispensed for pertussis (79%), whereas both beta-lactams (36.3%) and macrolides (35.4%) were used for cases of influenza. There was no dominant antibiotic class dispensed among those with nontyphoidal salmonella. Given concerns regarding increasing antibiotic resistance, the high proportion of adults with influenza and nontyphoidal salmonella cases dispensed antibiotics indicate the need for further strengthening of antimicrobial stewardship by raising education and awareness of guidelines for managing these infections.
抗生素不推荐用于治疗单纯性流感或非伤寒型沙门氏菌感染，而推荐用于当前百日咳感染。我们调查了在社区居住的老年人群中这些建议的遵循情况。
这是一项基于人群的前瞻性队列研究，研究对象为澳大利亚 45 岁及以上的成年人，随后通过记录链接，获取了 2009 年 1 月 1 日至 2015 年 12 月 31 日期间实验室确诊的流感、百日咳和非伤寒型沙门氏菌感染通知、住院记录和抗生素配药数据。估计了感染人群中使用抗生素的比例，并检查了与抗生素处方相关的特征。
在符合分析条件的队列中，有 1056 例流感、151 例百日咳和 334 例非伤寒型沙门氏菌感染。在感染发病日期前后 10 天的窗口期内，分别有 56.2%（594/1056）的流感、78.8%（119/151）的百日咳和 39.5%（132/334）的非伤寒型沙门氏菌病例使用了抗生素。抗生素的使用与大多数参与者的特征无关，包括是否有合并症、患者年龄和记录的合并症。大环内酯类是治疗百日咳的主要抗生素类别（79%），而治疗流感的抗生素类别为β-内酰胺类（36.3%）和大环内酯类（35.4%）。在非伤寒型沙门氏菌感染中，没有一种主要的抗生素类别。
鉴于对抗生素耐药性日益增加的担忧，给予流感和非伤寒型沙门氏菌感染的成年人使用抗生素的比例较高，这表明需要进一步加强抗菌药物管理，提高管理这些感染的指南的教育和认识。
