Fulgenzio Chiara, Massari Marco, Traversa Giuseppe, Da Cas Roberto, Ferrante Gianluigi, Aschbacher Richard, Moser Verena, Pagani Elisabetta, Vestri Anna Rita, Massidda Orietta, Kurotschka Peter Konstantin
Department of Public Health and Infectious Diseases, Postgraduate School of Medical Statistics and Biometry, University of Rome "La Sapienza", 00185 Rome, Italy.
Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy.
Antibiotics (Basel). 2021 Apr 16;10(4):451. doi: 10.3390/antibiotics10040451.
Research is lacking on the reversibility of antimicrobial resistance (AMR). Thus, we aimed to determine the influence of previous antibiotic use on the development and decay over time of third generation cephalosporin (3GC)-resistance of . Using the database of hospital laboratories of the Autonomous Province of Bolzano/Bozen (Italy), anonymously linked to the database of outpatient pharmaceutical prescriptions and the hospital discharge record database, this matched case-control study was conducted including as cases all those who have had a positive culture from any site for 3GC resistant (3GCREC) during a 2016 hospital stay. Data were analyzed by conditional logistic regression. 244 cases were matched to 1553 controls by the date of the first isolate. Male sex (OR 1.49, 95% CI 1.10-2.01), older age (OR 1.11, 95% CI 1.02-1.21), the number of different antibiotics taken in the previous five years (OR 1.20, 95% CI 1.08-1.33), at least one antibiotic prescription in the previous year (OR 1.92, 95% CI 1.36-2.71), and the diagnosis of diabetes (OR 1.57, 95% CI 1.08-2.30) were independent risk factors for 3GCREC colonization/infection. Patients who last received an antibiotic prescription two years or three to five years before hospitalization showed non-significant differences with controls (OR 0.97, 95% CI 0.68-1.38 and OR 0.85, 95% CI 0.59-1.24), compared to an OR of 1.92 (95% CI 1.36-2.71) in those receiving antibiotics in the year preceding hospitalization. The effect of previous antibiotic use on 3GC-resistance of is highest after greater cumulative exposure to any antibiotic as well as to 3GCs and in the first 12 months after antibiotics are taken and then decreases progressively.
关于抗菌药物耐药性（AMR）可逆性的研究尚缺。因此，我们旨在确定既往使用抗生素对肺炎克雷伯菌第三代头孢菌素（3GC）耐药性产生及随时间衰减的影响。利用意大利博尔扎诺/博岑自治省医院实验室数据库，并将其与门诊药房处方数据库及医院出院记录数据库进行匿名关联，开展了这项匹配病例对照研究，将2016年住院期间任何部位培养出3GC耐药肺炎克雷伯菌（3GCREC）呈阳性的所有患者纳入病例组。数据采用条件逻辑回归分析。按首次分离日期将244例病例与1553例对照进行匹配。男性（比值比1.49，95%置信区间1.10 - 2.01）、年龄较大（比值比1.11，95%置信区间1.02 - 1.21）、过去五年服用不同抗生素的数量（比值比1.20，95%置信区间1.08 - 1.33）、前一年至少有一次抗生素处方（比值比1.92，95%置信区间1.36 - 2.71）以及糖尿病诊断（比值比1.57，95%置信区间1.08 - 2.30）是3GCREC定植/感染的独立危险因素。与住院前一年接受抗生素治疗的患者比值比为1.92（95%置信区间1.36 - 2.71）相比，住院前两年或三至五年最后一次接受抗生素处方的患者与对照组无显著差异（比值比0.97，95%置信区间0.68 - 1.38和比值比0.85，95%置信区间0.59 - 1.24）。既往使用抗生素对肺炎克雷伯菌3GC耐药性的影响在累积接触任何抗生素以及3GCs量更大时最高，且在服用抗生素后的前12个月内，随后逐渐降低。
