Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.
J Antimicrob Chemother. 2021 Jan 29;76(Suppl 1):i12-i18. doi: 10.1093/jac/dkaa493.
Antimicrobial stewardship programmes are widely considered to be a core component of the response to the antimicrobial resistance threat. However, a positive impact of these interventions in terms of microbiological outcomes remains difficult to demonstrate, especially when focusing on specific resistant phenotypes. The first part of this review aims to explore the complex relationship between antibiotic exposure and resistance development in KPC-producing Klebsiella pneumoniae. In the second part we aim to summarize published examples of antimicrobial stewardship interventions intended to impact on the epidemiology of KPC-producing K. pneumoniae. For this purpose, a literature search was performed and seven studies were included in the review. Both restrictive and non-restrictive interventions were associated with an overall reduction in antibiotic consumption, and a decrease in carbapenem resistance rates was observed in five studies. The overall quality of the evidence was low, mainly due to the poor reporting of microbiological outcomes, lack of a control group and suboptimal study design. Although the link between antibiotic use and resistance development is supported by strong evidence, demonstrating the impact of antimicrobial stewardship interventions on microbiological outcomes remains difficult. Studies with adequate design and appropriate outcome measures are needed to further promote antimicrobial stewardship and elucidate which interventions are more successful for controlling the spread of KPC-producing K. pneumoniae.
抗菌药物管理计划被广泛认为是应对抗菌药物耐药威胁的核心组成部分。然而，这些干预措施在微生物学结果方面的积极影响仍然难以证明，特别是当关注特定的耐药表型时。这篇综述的第一部分旨在探讨产 KPC 肺炎克雷伯菌中抗生素暴露与耐药发展之间的复杂关系。在第二部分，我们旨在总结已发表的旨在影响产 KPC 肺炎克雷伯菌流行病学的抗菌药物管理干预措施的例子。为此，进行了文献检索，有 7 项研究被纳入综述。限制和非限制干预都与抗生素总消耗量的减少有关，并且在 5 项研究中观察到碳青霉烯类耐药率下降。证据的总体质量较低，主要是由于微生物学结果报告不佳、缺乏对照组和研究设计不理想。尽管抗生素使用与耐药发展之间的联系有强有力的证据支持，但证明抗菌药物管理干预措施对微生物学结果的影响仍然具有挑战性。需要进行设计合理和采用适当结果衡量指标的研究，以进一步促进抗菌药物管理，并阐明哪些干预措施更成功地控制产 KPC 肺炎克雷伯菌的传播。
