特定的抗菌药物管理干预措施是否会对革兰氏阴性杆菌的碳青霉烯类耐药性产生影响？一项多中心准实验性生态学研究：时间趋势分析和碳青霉烯酶的特征。
Do specific antimicrobial stewardship interventions have an impact on carbapenem resistance in Gram-negative bacilli? A multicentre quasi-experimental ecological study: time-trend analysis and characterization of carbapenemases.
机构信息
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio/CSIC/University of Seville/Institute of Biomedicine of Seville (IBiS), Seville, Spain.
Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Microbiology, University of Seville, Institute of Biomedicine of Seville (IBiS), Seville, Spain.
出版信息
J Antimicrob Chemother. 2021 Jun 18;76(7):1928-1936. doi: 10.1093/jac/dkab073.
BACKGROUND
Carbapenem-resistant Gram-negative bacilli (CR-GNB) are among the most threatening microorganisms worldwide and carbapenem use facilitates their spread. Antimicrobial stewardship programmes (ASPs) can help to optimize the use of antibiotics. This study evaluates the impact of a multifaceted educational ASP on carbapenem use and on the epidemiology of CR-GNB.
METHODS
We conducted a quasi-experimental, time-series study in seven hospitals, from January 2014 to September 2018. The key intervention was composed of educational interviews promoting the appropriate use of carbapenems. The primary endpoints were carbapenem consumption and incidence density (ID) of CR-GNB. All non-duplicated CR-GNB clinical isolates were tested using phenotypic assays and PCR for the presence of carbapenemases. Joinpoint regression and interrupted time-series analyses were used to determine trends.
RESULTS
A decrease in carbapenem consumption throughout the study period [average quarterly percentage change (AQPC) -1.5%, P < 0.001] and a -8.170 (-16.064 to -0.277) level change following the intervention were observed. The ID of CR-Acinetobacter baumannii decreased (AQPC -3.5%, P = 0.02) and the overall ID of CR-GNB remained stable (AQPC -0.4%, P = 0.52). CR-GNB, CR-Pseudomonas aeruginosa and CR-A. baumannii IDs per hospital correlated with the local consumption of carbapenems. The most prevalent carbapenem resistance mechanisms were OXA-23 for CR-A. baumannii (76.1%), OXA-48 for CR-Klebsiella pneumoniae (66%) and no carbapenemases for CR-P. aeruginosa (91.7%). The epidemiology of carbapenemases was heterogeneous throughout the study, especially for carbapenemase-producing Enterobacteriaceae.
CONCLUSIONS
In conclusion, a multifaceted, educational interview-based ASP targeting carbapenem prescribing reduced carbapenem use and the ID of CR-A. baumannii.
背景
耐碳青霉烯革兰氏阴性杆菌（CR-GNB）是全球最具威胁性的微生物之一，而碳青霉烯类药物的使用促进了它们的传播。抗菌药物管理计划（ASPs）有助于优化抗生素的使用。本研究评估了一种多方面的教育性 ASP 对碳青霉烯类药物使用和 CR-GNB 流行病学的影响。
方法
我们在 2014 年 1 月至 2018 年 9 月期间在七家医院进行了一项准实验性时间序列研究。关键干预措施包括促进碳青霉烯类药物合理使用的教育性访谈。主要终点是碳青霉烯类药物的消耗量和耐碳青霉烯类革兰氏阴性杆菌的发病率密度（ID）。所有非重复的耐碳青霉烯类革兰氏阴性杆菌临床分离株均使用表型检测和 PCR 检测碳青霉烯酶的存在。采用 Joinpoint 回归和中断时间序列分析来确定趋势。
结果
在整个研究期间，碳青霉烯类药物的消耗量呈下降趋势（平均季度百分比变化（AQPC）为-1.5%，P<0.001），并且在干预后下降了 8.170（-16.064 至-0.277）水平（P<0.001）。耐碳青霉烯类鲍曼不动杆菌的 ID 下降（AQPC-3.5%，P=0.02），而耐碳青霉烯类革兰氏阴性杆菌的总体 ID 保持稳定（AQPC-0.4%，P=0.52）。每个医院的耐碳青霉烯类革兰氏阴性杆菌、耐碳青霉烯类铜绿假单胞菌和耐碳青霉烯类鲍曼不动杆菌的 ID 与当地碳青霉烯类药物的消耗量相关。最常见的碳青霉烯类耐药机制是耐碳青霉烯类鲍曼不动杆菌的 OXA-23（76.1%）、耐碳青霉烯类肺炎克雷伯菌的 OXA-48（66%）和耐碳青霉烯类铜绿假单胞菌的无碳青霉烯酶（91.7%）。碳青霉烯酶的流行病学在整个研究过程中是异质的，尤其是对于产碳青霉烯酶的肠杆菌科。
结论
总之，针对碳青霉烯类药物处方的多方面、基于教育性访谈的 ASP 减少了碳青霉烯类药物的使用和耐碳青霉烯类鲍曼不动杆菌的 ID。
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