Wang Ying, Zhang Xinping, Wang Xuemei, Lai Xiaoquan
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, People's Republic of China.
Department of Nosocomial Infection Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, People's Republic of China.
Infect Drug Resist. 2021 Aug 31;14:3541-3552. doi: 10.2147/IDR.S329477. eCollection 2021.
Empirical antibiotic therapy should follow the local bacterial susceptibility, and the breakpoints revisions of the antimicrobial susceptibility testing can reflect the changes in the antimicrobial susceptibility of bacteria. This study aimed to analyze whether the changes in the antimicrobial susceptibility to antibiotics caused by the breakpoint revision will affect the empirical antibiotic therapy and its appropriateness.
A retrospective study was conducted among 831 hospitalized patients infected by , , and from April 10, 2018, to April 11, 2020. We evaluated the appropriateness of empirical therapy based on the antimicrobial susceptibility testing results. The rate of empirical use and appropriateness of fluoroquinolones was calculated, and logistic regression was used to analyze influencing factors of empirical use of fluoroquinolones.
The susceptibility rate of the three bacteria to levofloxacin (50.78% vs 32.06%) and ciprofloxacin (48.45% vs 21.90%) was decreased (P<0.001), while the resistance rate to levofloxacin (45.74% vs 58.73%) and ciprofloxacin (46.90% vs 66.67%) was increased (P<0.001) after the breakpoints revision. The empirical usage rate of fluoroquinolones in patients infected with , , or was 20.94%, which was influenced by the breakpoint revision (P=0.022), age (P=0.007), and the department (P=0.006); the appropriateness rate was 28.74%, affected by the pathogenic bacteria (P=0.001) and multidrug-resistant microorganism (P=0.001), department (P=0.024), and the length of stay before the empirical therapy (P=0.016).
The susceptibility of bacteria to antibiotics has changed significantly after the breakpoint revision while the clinicians' empirical therapy failure to change accordingly, which results in the decrease of the appropriateness of empirical use. It is enlightened that we should conduct more research to evaluate the rational use of antibiotics from the laboratory perspective and carry out interventions such as education and supervision to strengthen the collaboration between the microbiology laboratories and clinicians to improve the empirical antibiotic therapy and slow down the antimicrobial resistance.
经验性抗生素治疗应遵循当地细菌药敏情况，抗菌药物敏感性试验的折点修订可反映细菌药敏的变化。本研究旨在分析折点修订引起的抗生素药敏变化是否会影响经验性抗生素治疗及其合理性。
对2018年4月10日至2020年4月11日期间831例因[具体细菌名称1]、[具体细菌名称2]和[具体细菌名称3]感染而住院的患者进行回顾性研究。我们根据抗菌药物敏感性试验结果评估经验性治疗的合理性。计算氟喹诺酮类药物的经验性使用比例及合理性，并采用逻辑回归分析氟喹诺酮类药物经验性使用的影响因素。
折点修订后，这三种细菌对左氧氟沙星（50.78%对32.06%）和环丙沙星（48.45%对21.90%）的敏感率降低（P<0.001），而对左氧氟沙星（45.74%对58.73%）和环丙沙星（46.90%对66.67%）的耐药率升高（P<0.001）。感染[具体细菌名称1]、[具体细菌名称2]或[具体细菌名称3]的患者中氟喹诺酮类药物的经验性使用率为20.94%，受折点修订（P=0.022）、年龄（P=0.007）和科室（P=0.006）影响；合理率为28.74%，受病原菌（P=0.001）、多重耐药微生物（P=0.001）、科室（P=0.024）及经验性治疗前住院时间（P=0.016）影响。
折点修订后细菌对抗生素的敏感性发生了显著变化，而临床医生的经验性治疗未能相应改变，导致经验性使用的合理性下降。启示我们应从实验室角度开展更多研究以评估抗生素的合理使用，并进行教育和监督等干预措施，加强微生物实验室与临床医生之间的协作，以改善经验性抗生素治疗并减缓抗菌药物耐药性。
