Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur; 25 rue du docteur Roux, 75015, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP; 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, France; Université Paris-Saclay, AgroParisTech, INRAE, UMR MIA-Paris; 16 rue Claude Bernard, 75005, Paris, France.
Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur; 25 rue du docteur Roux, 75015, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP; 16 Avenue Paul Vaillant Couturier, 94800 Villejuif, France.
Int J Antimicrob Agents. 2021 Jun;57(6):106339. doi: 10.1016/j.ijantimicag.2021.106339. Epub 2021 Apr 20.
Antibiotic stewardship requires clear insight into antibiotic overuse and the syndromes that lead to prescription. The aim of this study was to estimate the proportion of antibiotic prescriptions attributable to acute lower respiratory tract infections (LRTIs) during the cold season. Using individual data from the French National Health Insurance (NHI) database, weekly time series were constructed of outpatient antibiotic (beta-lactams and macrolides) prescriptions between January 2010 and December 2017. Time series were also constructed of tenth edition of the International Classification of Diseases (ICD-10) discharge diagnoses from a national network of emergency departments (EDs), stratified by specific syndromes (pneumonia, bronchitis, bronchiolitis and influenza-like illness). The number of outpatient antibiotic prescriptions attributable to these syndromes during the cold season in France was modeled and estimated for the entire population, young children (≤5 years) and the elderly (≥75 years). LRTIs accounted for 40% (95% confidence interval [95% CI]: 29, 52) of outpatient antibiotic use during the cold season for the entire population, including 23% (95% CI: 13, 33) and 17% (95% CI: 13, 22) for bacterial and viral infections, respectively. In children and the elderly, viral LRTIs were the reason for 38% (95% CI: 31, 46) and 20% (95% CI: 16, 25) of outpatient antibiotic use, respectively (with bronchiolitis accountable for half of use in young children). In the entire population and in children, respectively, outpatient antibiotic overuse attributable to viral LRTIs was estimated to be 289 (95% CI: 221, 374) and 1588 (95% CI: 1295, 1922) prescriptions per 100 000 inhabitants per week. These results highlight the major role of viral infections in driving antibiotic prescriptions, particularly in young children.
抗生素管理需要清楚地了解抗生素的过度使用以及导致处方的综合征。本研究旨在估计在寒冷季节中，急性下呼吸道感染（LRTI）导致的抗生素处方比例。使用来自法国国家健康保险（NHI）数据库的个人数据，构建了 2010 年 1 月至 2017 年 12 月期间门诊抗生素（β-内酰胺类和大环内酯类）处方的每周时间序列。还根据特定综合征（肺炎、支气管炎、细支气管炎和流感样疾病）对来自国家急诊部网络的第十版国际疾病分类（ICD-10）出院诊断构建了时间序列。使用模型对法国寒冷季节期间这些综合征导致的门诊抗生素处方数量进行了建模和估计，包括整个人群、幼儿（≤5 岁）和老年人（≥75 岁）。LRTI 占寒冷季节期间整个人群门诊抗生素使用的 40%（95%置信区间[95%CI]：29，52），其中细菌性和病毒性感染分别占 23%（95%CI：13，33）和 17%（95%CI：13，22）。在儿童和老年人中，病毒性 LRTI 分别占门诊抗生素使用的 38%（95%CI：31，46）和 20%（95%CI：16，25）（细支气管炎占幼儿使用的一半）。在整个人群和儿童中，分别估计病毒性 LRTI 导致的门诊抗生素过度使用为每周每 100000 名居民 289（95%CI：221，374）和 1588（95%CI：1295，1922）处方。这些结果突出表明病毒感染在驱动抗生素处方方面起着重要作用，特别是在幼儿中。
