Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan.
Nursing and Management, Mackay Junior College of Medicine, Taipei, Taiwan.
Am J Trop Med Hyg. 2022 Jun 13;107(2):467-473. doi: 10.4269/ajtmh.21-1242. Print 2022 Aug 17.
Carbapenem-resistant Enterobacteriales has become a threat in Taiwan. This is the first local study focusing on the association between carbapenem-resistant Enterobacteriales and antimicrobial consumption. From January 2012 to December 2020, data were collected in a tertiary care hospital in Taipei, Taiwan. Antimicrobial consumption was estimated by the defined daily dose/1,000 patient-days. During the same period, the prevalence of carbapenem-resistant Escherichia coli (CREC) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were collected through routine surveillance data. The following retrospective analyses were conducted: 1) analysis of antimicrobial consumption over time, (2) analysis and forecast of CREC and CRKP prevalence over time, and 3) analysis of correlation between antimicrobial consumption and the prevalence of CREC and CRKP. The consumption of piperacillin/tazobactam (β = 0.615), fluoroquinolones (β = 0.856), meropenem (β = 0.819), and doripenem (β = 0.891) increased during the observation period (P < 0.001), and the consumption of aminoglycosides (β = -0.852) and imipenem/cilastatin (β = -0.851) decreased (P < 0.001). The prevalence of CRKP rose over time (β = 0.522, P = 0.001) and correlated positively with the consumption of fluoroquinolones, levofloxacin, penicillin/β-lactamase inhibitor, piperacillin/tazobactam, meropenem, and doripenem (P < 0.05). The prevalence of CRKP and CREC both correlated negatively with consumption of aminoglycosides (P < 0.01). The prevalence of CRKP in our hospital increased as the forecast predicted based on an autoregressive integrated moving average model. This study provides alarming messages for members participating in antimicrobial stewardship programs, including the increasing prevalence of CRKP, the increasing consumption of broad-spectrum antibiotics, and the positive correlation between them.
耐碳青霉烯肠杆菌科已成为台湾的威胁。这是第一项专注于耐碳青霉烯肠杆菌科与抗菌药物消耗之间关联的本地研究。从 2012 年 1 月至 2020 年 12 月，在台湾台北的一家三级保健医院收集数据。抗菌药物消耗通过限定日剂量/1000 患者日来估计。同期，通过常规监测数据收集耐碳青霉烯大肠埃希菌 (CREC) 和耐碳青霉烯肺炎克雷伯菌 (CRKP) 的流行率。进行了以下回顾性分析：1）随时间推移的抗菌药物消耗分析，2）随时间推移的 CREC 和 CRKP 流行率分析和预测，以及 3）抗菌药物消耗与 CREC 和 CRKP 流行率之间的相关性分析。在观察期间，哌拉西林/他唑巴坦（β=0.615）、氟喹诺酮类（β=0.856）、美罗培南（β=0.819）和多利培南（β=0.891）的消耗增加（P<0.001），而氨基糖苷类（β=-0.852）和亚胺培南/西司他丁（β=-0.851）的消耗减少（P<0.001）。CRKP 的流行率随时间推移而上升（β=0.522，P=0.001），与氟喹诺酮类、左氧氟沙星、青霉素/β-内酰胺酶抑制剂、哌拉西林/他唑巴坦、美罗培南和多利培南的消耗呈正相关（P<0.05）。CRKP 和 CREC 的流行率与氨基糖苷类的消耗呈负相关（P<0.01）。基于自回归综合移动平均模型的预测，我院 CRKP 的流行率呈上升趋势。这项研究为参与抗菌药物管理计划的成员提供了令人警醒的信息，包括 CRKP 流行率上升、广谱抗生素消耗增加以及两者之间的正相关关系。
