Department of Healthcare-Associated Infection Control Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
Microb Drug Resist. 2022 Jun;28(6):660-669. doi: 10.1089/mdr.2021.0326. Epub 2022 May 30.
The main objective was to assess the correlation between antibiotic use and carbapenem-resistant (CRKP) and carbapenem-resistant (CREC) induction by antibiotics. A retrospective cohort study was conducted from January 2017 to December 2020. This study included patients with and Kaplan-Meier analysis and Cox proportional hazard model were used to estimate the hazard of carbapenem-resistant Enterobacterales (CRE), whereas restricted cubic spline regression was used to visualize the hazard of CRE by antibiotics at different doses. Two thousand fifty-six patients and 3,243 patients were included. After Cox proportional hazard model analysis, carbapenems or 1st-cephalospoins or penicillin monotherapy, male and ICU admission were associated with CRKP. CREC was associated with quinolone monotherapy. Time-to-event analysis indicated that carbapenem, β-lactamase inhibitor mixtures, and quinolones were associated with higher 30-day CRKP hazards than other antibiotics ( = 33.670, < 0.001). Further restricted cubic spline regression analysis found that the hazard of CRKP induction decreased with the increased dose of β-lactamase inhibitor mixtures, but there was no significant change in the hazard ratio of CRKP induction with the increased dose of quinolones. Moreover, there was an obvious characteristic of "parabolic curve" for the hazard of CREC induction due to β-lactamase inhibitor mixtures, and the hazard value gradually increased with the dose, reached the maximum at 24 g, and finally gradually decreased from 26 g. Rational use of antibiotics should be implemented and antimicrobial stewardship policies should be adjusted according to the characteristics of each hospital.
目的是评估抗生素使用与碳青霉烯类耐药肠杆菌科（CRE）的相关性。采用回顾性队列研究，纳入 2017 年 1 月至 2020 年 12 月的患者。Kaplan-Meier 分析和 Cox 比例风险模型用于估计碳青霉烯类耐药肠杆菌科（CRE）的风险，而限制三次样条回归用于可视化不同剂量抗生素对 CRE 的风险。共纳入 2056 例和 3243 例患者。Cox 比例风险模型分析后，碳青霉烯类、1 代头孢菌素或青霉素单药、男性和 ICU 入住与 CRKP 相关。喹诺酮单药与 CREC 相关。时间事件分析表明，碳青霉烯类、β-内酰胺酶抑制剂合剂和喹诺酮类与 30 天 CRKP 风险增加相关（ = 33.670， < 0.001）。进一步的限制三次样条回归分析发现，CRKP 诱导的风险随着β-内酰胺酶抑制剂合剂剂量的增加而降低，但喹诺酮类药物剂量增加对 CRKP 诱导的风险比没有显著变化。此外，由于β-内酰胺酶抑制剂合剂，CREC 诱导的风险存在明显的“抛物线曲线”特征，随着剂量的增加，风险值逐渐增加，在 24 g 时达到最大值，最终从 26 g 开始逐渐下降。应合理使用抗生素，并根据医院的特点调整抗菌药物管理政策。
