Health Campus, The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands.
Department of Infectious Diseases, Leiden University Medical Center, The Hague, The Netherlands.
J Antimicrob Chemother. 2023 May 3;78(5):1245-1252. doi: 10.1093/jac/dkad082.
We studied trends in antibiotic prescribing by primary care and assessed the associations between generated antibiotic selection pressure (ASP) and the prevalence of sentinel drug-resistant microorganisms (SDRMs).
The volume of antibiotic prescribing in primary and hospital care expressed in DDD/1000 inhabitants per day and the prevalences of SDRMs in European countries where GPs act as gatekeepers were obtained from the European Centre for Disease Control ESAC-NET. Associations were tested between (i) DDD and (ii) the Antibiotic Spectrum Index (ASI) as a proxy indicator for ASP, and the prevalences of three SDRMs: MRSA, MDR Escherichia coli and Streptococcus pneumoniae resistant to macrolides.
Fourteen European countries were included. Italy, Poland and Spain had the highest prevalence of SDRMs and prescribed the highest volume of antibiotics in primary care (average 17 DDD per 1000 inhabitants per day), approximately twice that of countries with the lowest volumes. Moreover, the ASIs of these high antibiotic volume countries were approximately three times higher than those of the low-volume countries. Cumulative ASI showed the strongest association with a country's prevalence of SDRMs. The cumulative ASI generated from primary care was about four to five times higher than the cumulative ASI generated by hospital care.
Prevalences of SDRMs are associated with the volume of antimicrobial prescribing and in particular broad-spectrum antibiotics in European countries where GPs act as gatekeepers. The impact of ASP generated from primary care on increasing antimicrobial resistance may be much larger than currently assumed.
我们研究了初级保健中抗生素处方的趋势，并评估了产生的抗生素选择压力（ASP）与哨兵耐药微生物（SDRM）流行率之间的关联。
从欧洲疾病预防控制中心 ESAC-NET 获取欧洲国家初级保健和医院保健中抗生素处方量（以每 1000 人每天 DDD 表示）和 GP 作为把关人的 SDRM 流行率。测试了以下（i）DDD 和（ii）抗生素谱指数（ASI）作为 ASP 替代指标与三种 SDRM（耐甲氧西林金黄色葡萄球菌、耐多药大肠埃希菌和对大环内酯类耐药肺炎链球菌）流行率之间的关联。
纳入了 14 个欧洲国家。意大利、波兰和西班牙的 SDRM 流行率最高，初级保健中抗生素处方量最高（平均每天每 1000 人 17 DDD），大约是处方量最低国家的两倍。此外，这些高抗生素用量国家的 ASI 大约是低用量国家的三倍。累积 ASI 与国家 SDRM 流行率的关联最强。来自初级保健的累积 ASI 比来自医院保健的累积 ASI 高约 4 至 5 倍。
在 GP 作为把关人的欧洲国家，SDRM 的流行率与抗菌药物处方量，特别是广谱抗生素有关。来自初级保健的 ASP 对增加抗菌药物耐药性的影响可能比目前认为的要大得多。
