肠杆菌科和屎肠球菌中的抗菌药物使用和抗菌药物耐药性：时间序列分析。

Antimicrobial use and antimicrobial resistance in Enterobacterales and Enterococcus faecium: a time series analysis.

机构信息

Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.

HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.

出版信息

J Hosp Infect. 2022 Feb;120:57-64. doi: 10.1016/j.jhin.2021.11.003. Epub 2021 Nov 12.

DOI:10.1016/j.jhin.2021.11.003

PMID:34780809

Abstract

BACKGROUND

Irish and European antimicrobial resistance (AMR) surveillance data have highlighted increasing AMR in Enterobacterales and vancomycin resistance in Enterococcus faecium (VRE). Antimicrobial consumption (AC) in Irish hospital settings is also increasing.

METHODS

A retrospective time series analysis (TSA) was conducted to evaluate the trends and possible relationship between AC of selected antimicrobials and AMR in Enterobacterales and vancomycin resistance in E. faecium, from January 2017 to December 2020.

RESULTS

Increased AC was seen with ceftriaxone (P = 0.0006), piperacillin/tazobactam (P = 0.03) and meropenem (P = 0.054), while ciprofloxacin and gentamicin use trended downwards. AMR rates in Escherichia coli, Klebsiella pneumoniae and other Enterobacterales were largely stable or decreasing, an increase in ertapenem resistance in the latter from 0.58% in 2017 to 5.19% in 2020 (P = 0.003) being the main concern. The proportion of E. faecium that was VRE did not changed significantly (64% in 2017; 53% in 2020, P = 0.1). TSA identified a correlation between piperacillin/tazobactam use and the decreasing rate of ceftriaxone resistance in E. coli.

CONCLUSION

Our data suggest that the hospital antimicrobial stewardship programme is largely containing, but not reducing AMR in key nosocomial pathogens. An increase in AC following the COVID-19 pandemic appears as yet to have had no impact on AMR rates.

摘要

背景

爱尔兰和欧洲的抗菌药物耐药性（AMR）监测数据显示，肠杆菌科的 AMR 不断增加，屎肠球菌（VRE）对万古霉素的耐药性也在增加。爱尔兰医院环境中的抗菌药物消耗（AC）也在增加。

方法

本研究采用回顾性时间序列分析（TSA），评估了 2017 年 1 月至 2020 年 12 月期间，选定抗菌药物的 AC 与肠杆菌科的 AMR 和屎肠球菌的万古霉素耐药性之间的趋势和可能的关系。

结果

头孢曲松（P=0.0006）、哌拉西林/他唑巴坦（P=0.03）和美罗培南（P=0.054）的 AC 增加，而环丙沙星和庆大霉素的使用呈下降趋势。大肠埃希菌、肺炎克雷伯菌和其他肠杆菌科的 AMR 率基本稳定或下降，厄他培南耐药率从 2017 年的 0.58%上升到 2020 年的 5.19%（P=0.003）是主要关注点。屎肠球菌万古霉素耐药株的比例没有显著变化（2017 年为 64%；2020 年为 53%，P=0.1）。TSA 确定了哌拉西林/他唑巴坦的使用与大肠埃希菌头孢曲松耐药率下降率之间的相关性。