Gupta Vikas, Yu Kalvin C, Kabler Heidi, Watts Janet A, Amiche Amine
Becton, Dickinson and Company, Franklin Lakes, New Jersey 07417, USA.
Sanofi Pasteur, Swiftwater, Pennsylvania, USA.
Open Forum Infect Dis. 2022 Jan 25;9(3):ofac039. doi: 10.1093/ofid/ofac039. eCollection 2022 Mar.
Viral infections are often treated with empiric antibiotics due to suspected bacterial coinfections, leading to antibiotic overuse. We aimed to describe antibiotic resistance (ABR) trends and their association with the influenza season in ambulatory and inpatient settings in the United States.
We used the BD Insights Research Database to evaluate antibiotic susceptibility profiles in 30-day nonduplicate bacterial isolates collected from patients >17 years old at 257 US healthcare institutions from 2011 to 2019. We investigated ABR in Gram-positive ( and ) and Gram-negative (Enterobacterales [ENT], [PSA], and spp [ACB]) bacteria expressed as the proportion of isolates not susceptible ([NS], intermediate or resistant) and resistance per 100 admissions (inpatients only). Antibiotics included carbapenems (Carb), fluoroquinolones (FQ), macrolides, penicillin, extended-spectrum cephalosporins (ESC), and methicillin. Generalized estimating equations models were used to evaluate monthly trends in ABR outcomes and associations with community influenza rates.
We identified 8 250 860 nonduplicate pathogens, including 154 841 Gram-negative Carb-NS, 1 502 796 Gram-negative FQ-NS, 498 012 methicillin-resistant (MRSA), and 44 131 NS . All rates per 100 admissions (macrolide-, penicillin-, and ESC-NS) were associated with influenza rates. Respiratory, but not nonrespiratory, MRSA was also associated with influenza. For Gram-negative pathogens, influenza rates were associated with the percentage of FQ-NS ENT, FQ-NS PSA, and Carb-NS ACB.
Our study showed expected increases in rates of ABR Gram-positive and identified small but surprising increases in ABR Gram-negative pathogens associated with influenza activity. These insights may help inform antimicrobial stewardship initiatives.
由于怀疑存在细菌合并感染，病毒感染常常采用经验性抗生素治疗，这导致了抗生素的过度使用。我们旨在描述美国门诊和住院环境中抗生素耐药性（ABR）趋势及其与流感季节的关联。
我们使用BD Insights研究数据库，评估了2011年至2019年期间在美国257家医疗机构从17岁以上患者中收集的30天内非重复细菌分离株的抗生素敏感性谱。我们调查了革兰氏阳性菌（和）和革兰氏阴性菌（肠杆菌科[ENT]、[PSA]和 spp[ACB]）中的ABR，以不敏感（[NS]，中介或耐药）分离株的比例和每100例入院患者（仅针对住院患者）的耐药率来表示。抗生素包括碳青霉烯类（Carb）、氟喹诺酮类（FQ）、大环内酯类、青霉素、广谱头孢菌素（ESC）和甲氧西林。使用广义估计方程模型来评估ABR结果的月度趋势以及与社区流感发病率的关联。
我们鉴定出8250860株非重复病原体，包括154841株革兰氏阴性碳青霉烯类不敏感菌、1502796株革兰氏阴性氟喹诺酮类不敏感菌、498012株耐甲氧西林金黄色葡萄球菌（MRSA）和44131株不敏感菌。每100例入院患者的所有耐药率（大环内酯类、青霉素类和ESC不敏感率）均与流感发病率相关。呼吸道MRSA而非非呼吸道MRSA也与流感相关。对于革兰氏阴性病原体，流感发病率与FQ不敏感的肠杆菌科、FQ不敏感的PSA和碳青霉烯类不敏感的ACB的百分比相关。
我们的研究显示革兰氏阳性菌的ABR率出现了预期的上升，并发现与流感活动相关的革兰氏阴性病原体的ABR有小幅度但令人惊讶的上升。这些见解可能有助于为抗菌药物管理举措提供信息。
