Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, England, United Kingdom.
Jean Golding Institute, Royal Fort House, University of Bristol, Bristol, England, United Kingdom.
PLoS One. 2020 May 14;15(5):e0232903. doi: 10.1371/journal.pone.0232903. eCollection 2020.
Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown.
To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections.
Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality.
In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance.
This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.
最近英国的抗生素管理政策导致了基层医疗配药的重大变化，但这是否对抗菌药物耐药性产生了影响尚不清楚。
评估英格兰西南部基层医疗配药变化与社区获得性大肠埃希菌尿路感染中抗菌药物耐药性之间的关系。
使用多水平逻辑回归模型，调查了英格兰西南部约 150 万患者的基层医疗实践中抗生素配药与 2013 年至 2016 年期间 152704 例社区获得性尿大肠埃希菌耐药性之间的关系。为了调整患者年龄、贫困程度和农村程度，对每个患者 1000 名登记患者的抗生素配药和药物-细菌之间的关系进行了研究。
与全国趋势一致，每 1000 名注册患者的抗生素总配药量下降了 11%。阿莫西林下降了 14%，头孢氨苄下降了 20%，环丙沙星下降了 24%，复方新诺明下降了 49%，甲氧苄啶下降了 8%。呋喃妥因增加了 7%。抗生素的减少与同一季度内同抗生素耐药性的降低有关：阿莫西林、环丙沙星和甲氧苄啶。随后的一个季度观察到对甲氧苄啶和阿莫西林的耐药性降低。抗生素配药的减少与头孢氨苄和复方新诺明的耐药性增加有关。增加的呋喃妥因配药与同一季度和随后一个季度的甲氧苄啶耐药性降低有关，而不会影响呋喃妥因耐药性。
对社区抗菌药物耐药性的全国性初级保健管理政策的评估表明，既有预期的好处，也有意外的危害。头孢氨苄和复方新诺明的耐药性增加可能是由于残留的混杂因素所致。迫切需要进行随机对照试验来调查因果关系。
