Direction des maladies infectieuses, Santé publique France, Saint-Maurice, France; Unité d'Hygiène et de Prévention des Infections, Centre Hospitalier Châteauroux - Le Blanc, Châteauroux, France.
Direction des maladies infectieuses, Santé publique France, Saint-Maurice, France.
J Hosp Infect. 2021 Aug;114:104-110. doi: 10.1016/j.jhin.2021.05.008. Epub 2021 May 27.
Monitoring the use of antimicrobials in hospitalized patients is critical owing to the risk of resistance selection. This study aimed to describe the patterns of antimicrobial prescription for the most frequent healthcare-associated infections (HAIs) in France, relating drugs and microbiological data.
We used data from the 2017 point-prevalence survey of HAI and antimicrobial use in France, a large nationally representative sample survey of inpatients. We sought unambiguous correspondence between individual indications of antibiotic regimen and HAI sites to determine which molecules were directed towards which pathogen, considering its resistance profile.
Among 75,698 adult patients from 401 hospitals, 5.1% had an active HAI and 4.3% were being treated for an HAI. The two most frequent antibiotic indications were lower respiratory tract (LRTI, 27.7%) and urinary tract infections (UTI, 18.4%). For LRTI, the most prescribed antibiotic was amoxicillin-clavulanic acid (27.6%) and most frequently isolated pathogens (each accounting for around 17% of isolates) were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Meticillin-resistant S. aureus LRTI was more likely to be treated with linezolid. For UTI, ofloxacin, ceftriaxone, amoxicillin/co-amoxiclav were most-prescribed (∼13% each) and E. coli predominantly isolated (52.0%). Extended-spectrum beta-lactamase-producing E. coli UTI were more likely treated by fosfomycin, pivmecillinam or ertapenem.
This study provides a baseline of antimicrobial use in relation to microbiological information in patients with the most common HAIs. These results can serve to direct future efforts in antimicrobial stewardship. Our work could be extended to a broader population, notably in Europe where similar surveys have been conducted.
由于存在耐药选择风险，监测住院患者的抗菌药物使用情况至关重要。本研究旨在描述法国最常见的医院获得性感染（HAI）的抗菌药物处方模式，并将药物与微生物数据相关联。
我们使用了 2017 年法国 HAI 和抗菌药物使用的全国代表性点患病率调查数据，该调查对住院患者进行了大型的、全国性的代表性抽样调查。我们寻求抗生素方案的个体指征与 HAI 部位之间的明确对应关系，以确定针对哪种病原体使用哪种药物，同时考虑其耐药谱。
在 401 家医院的 75698 名成年患者中，5.1%有活动性 HAI，4.3%正在接受 HAI 治疗。最常见的两种抗生素指征是下呼吸道感染（LRTI，27.7%）和尿路感染（UTI，18.4%）。对于 LRTI，最常开的抗生素是阿莫西林-克拉维酸（27.6%），最常分离的病原体（每种占分离物的约 17%）是金黄色葡萄球菌、铜绿假单胞菌和大肠杆菌。耐甲氧西林金黄色葡萄球菌 LRTI 更可能用利奈唑胺治疗。对于 UTI，氧氟沙星、头孢曲松、阿莫西林/克拉维酸最常开（各约 13%），主要分离出大肠杆菌（52.0%）。产超广谱β-内酰胺酶的大肠杆菌 UTI 更可能用磷霉素、匹美西林或厄他培南治疗。
本研究提供了与最常见 HAI 患者微生物信息相关的抗菌药物使用的基线数据。这些结果可以为未来的抗菌药物管理工作提供指导。我们的工作可以扩展到更广泛的人群，特别是在已经开展了类似调查的欧洲。
