Faculty of Pharmacy, Osaka Ohtani University, Tondabayashi-shi, Osaka, Japan.
Sakai City Medical Center, Sakai-shi, Osaka, Japan.
J Clin Pharm Ther. 2021 Apr;46(2):395-407. doi: 10.1111/jcpt.13296. Epub 2020 Oct 28.
Though most medical institutions calculate antimicrobial susceptibility and resistance rates of microbes isolated at their own facility as part of their efforts to promote the proper use of antibiotics, very few, if any, regularly monitor cross-resistance rates between antimicrobial agents. The authors have devised a tool in the form of a cross-resistance rate correlation diagram (CRR diagram) that allows easy identification of increases or decreases in, or changes in the pattern of, antimicrobial cross-resistance. The objective was to perform an analysis by CRR diagrams of the effect of relocation to a newly built facility on antimicrobial resistance and cross-resistance rates at a medical facility.
The Sakai City Medical Center relocated in July 2015 to a newly built facility located in a different primary medical care zone 3.5 km away. Based on the drug susceptibility test data compiled at the Sakai City Medical Center, resistance and cross-resistance rates of Pseudomonas aeruginosa before and after the relocation of the hospital facility were calculated, and the rates were assessed using CRR diagrams.
It was possible to confirm the effect of hospital relocation on antibiotic susceptibility of P aeruginosa in terms of changes in resistance and cross-resistance rates. The effect of the facility's relocation on cross-resistance rates was particularly notable with respect to β-lactam antibiotics: cross-resistance rates among β-lactams decreased substantially, represented as a large wedge-shaped change towards the origin on the CRR diagram. Rates of cross-resistance between classes of antibiotics with a different mechanism of antibiotic action changed little.
Including cross-resistance rates in the routine monitoring of resistance and susceptibility rates practiced by a medical institution can provide a comprehensive insight into the dynamics of bacterial flora in the facility. CRR diagrams, which allow visualization of the status and changes in cross-resistance, not only provide a new perspective for clinicians, but they also contribute to the proper use of antibiotics and serve as a tool in the education of healthcare professionals and students about antibiotic resistance.
虽然大多数医疗机构将其设施中分离的微生物的抗生素敏感性和耐药率作为促进抗生素合理使用的一部分进行计算，但很少有医疗机构定期监测抗生素之间的交叉耐药率。作者设计了一种工具，以交叉耐药率相关图（CRR 图）的形式，便于识别抗生素交叉耐药性的增加、减少或模式变化。目的是通过 CRR 图分析医疗设施搬迁到新设施对微生物耐药性和交叉耐药率的影响。
佐贺市医疗中心于 2015 年 7 月搬迁到一个新的设施，该设施位于距离 3.5 公里的不同初级医疗保健区。根据佐贺市医疗中心的药敏试验数据，计算了医院设施搬迁前后铜绿假单胞菌的耐药率和交叉耐药率，并使用 CRR 图进行评估。
可以从耐药率和交叉耐药率的变化方面确认医院搬迁对铜绿假单胞菌抗生素敏感性的影响。设施搬迁对交叉耐药率的影响特别明显，β-内酰胺类抗生素的交叉耐药率显著下降，CRR 图上呈现出一个大的楔形变化，向原点方向移动。不同作用机制抗生素之间的抗生素类别交叉耐药率变化不大。
在医疗机构常规监测耐药率和敏感性率时包括交叉耐药率，可以全面了解设施内细菌菌群的动态变化。CRR 图可以直观地显示交叉耐药的状态和变化，不仅为临床医生提供了新的视角，还有助于抗生素的合理使用，并为医疗保健专业人员和学生的抗生素耐药性教育提供了工具。
