计算机化决策支持系统（CDSS）在初级保健中用于监测尿路感染中的抗菌药物耐药性。
Computerized decision support system (CDSS) use for surveillance of antimicrobial resistance in urinary tract infections in primary care.
机构信息
Antibioclic Steering Committee, Paris, France.
Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, F-75012 Paris, France.
出版信息
J Antimicrob Chemother. 2022 Feb 2;77(2):524-530. doi: 10.1093/jac/dkab392.
BACKGROUND
Hospital-based surveillance of antimicrobial resistance may be irrelevant as a guide to antimicrobial use for urinary tract infections (UTIs) in primary care.
OBJECTIVES
To highlight the value of online computerized decision support systems (CDSS) in providing information on the surveillance of antimicrobial resistance in community-acquired UTIs.
METHODS
We collected the susceptibility profile for key antibiotics by type of UTI involving Escherichia coli from 2017 to 2020, using queries for UTI (Q-UTI) submitted to a French CDSS. We compared these results with those from the MedQual French surveillance system for community-acquired UTI and the European Antimicrobial Resistance Surveillance Network (EARS-NET) for invasive infections.
RESULTS
We collected 43 591 Q-UTI, of which 10 192 (23%) involved E. coli: 40% cystitis, 32% male-UTI, and 27% pyelonephritis. Resistance was 41.3% (95% CI, 40.3%-42.2%) for amoxicillin, 16.6% (95% CI, 15.9%-17.3%) for fluoroquinolones, 6.6% (95% CI, 6.1%-7.0%) for third-generation cephalosporins (3GC), and 5.7% (95% CI, 5.2%-6.1%) for aminoglycosides. Resistance to amoxicillin was lower than that reported in MedQual (42.7%, P value = 0.004), and in EARS-NET (55.2%, P value < 0.001). For fluoroquinolones, resistance was higher than in MedQual (12.0%, P value < 0.001) and EARS-NET (15.8%, P value = 0.041). In complicated pyelonephritis and male UTI, fluoroquinolone resistance peaked at ∼20%. For 3GC, all UTI had higher resistance than in MedQual (3.5%, P value < 0.001), but lower than in EARS-NET (9.5%, P value < 0.001). Aminoglycoside resistance was not reported by MedQual, and was lower than in EARS-NET (7.1%, P value < 0.001).
CONCLUSIONS
CDSS can inform prescribers in real-time about the ecology and surveillance of E. coli resistance in community-acquired UTI. In complicated upper UTIs, they can underline the risk of empirical use of fluoroquinolones and suggest preferential use of 3GC.
背景
医院为基础的抗生素耐药性监测可能与初级保健中尿路感染（UTI）的抗生素使用指导无关。
目的
强调在线计算机化决策支持系统（CDSS）在提供社区获得性尿路感染中抗生素耐药性监测信息方面的价值。
方法
我们使用法国 CDSS 提交的 UTI 查询（Q-UTI），收集了 2017 年至 2020 年涉及大肠埃希菌的各种类型 UTI 的关键抗生素药敏谱。我们将这些结果与法国社区获得性 UTI 监测系统 MedQual 和欧洲抗生素耐药性监测网络（EARS-NET）的侵袭性感染进行了比较。
结果
我们共收集了 43591 例 Q-UTI，其中 10192 例（23%）涉及大肠埃希菌：40%为膀胱炎，32%为男性 UTI，27%为肾盂肾炎。对阿莫西林的耐药率为 41.3%（95%可信区间，40.3%-42.2%），对氟喹诺酮类的耐药率为 16.6%（95%可信区间，15.9%-17.3%），对第三代头孢菌素（3GC）的耐药率为 6.6%（95%可信区间，6.1%-7.0%），对氨基糖苷类的耐药率为 5.7%（95%可信区间，5.2%-6.1%）。阿莫西林的耐药率低于 MedQual（42.7%，P 值=0.004）和 EARS-NET（55.2%，P 值<0.001）。氟喹诺酮类的耐药率高于 MedQual（12.0%，P 值<0.001）和 EARS-NET（15.8%，P 值=0.041）。在复杂性肾盂肾炎和男性 UTI 中，氟喹诺酮类的耐药率高达约 20%。对于 3GC，所有 UTI 的耐药率均高于 MedQual（3.5%，P 值<0.001），但低于 EARS-NET（9.5%，P 值<0.001）。MedQual 未报告氨基糖苷类耐药性，且耐药率低于 EARS-NET（7.1%，P 值<0.001）。
结论
CDSS 可以实时为临床医生提供有关社区获得性 UTI 中大肠埃希菌耐药性的生态和监测信息。在复杂的上尿路感染中，它们可以强调经验性使用氟喹诺酮类药物的风险，并建议优先使用 3GC。
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