Collignon Peter, Beggs John, Robson Jennifer
Microbiology Department, ACT Pathology, Canberra Hospital, Garran, Australia.
Medical School, Australian National University, Canberra, Australia.
JAC Antimicrob Resist. 2024 Aug 8;6(4):dlae125. doi: 10.1093/jacamr/dlae125. eCollection 2024 Aug.
Antibiotic resistance is rising globally and is a major One Health problem. How much person-to-person transmission or 'contagion' contributes to the spread of resistant strains compared with antibiotic usage remains unclear. As part of its COVID-19 response, Australia introduced strict people movement restrictions in early 2020. Along with internal lockdown measures, movement of people into Australia from overseas was severely restricted. These circumstances provided a unique opportunity to examine the association of people movements with changes in resistance rates.
Monthly resistance data on over 646 000 urine isolates from 2016 till 2023 were modelled for statistical changes in resistance trends during pre-lockdown, lockdown and post-lockdown periods. Data were available for three clinical contexts (community, hospital and aged-care facilities). Data were also available for antibiotic usage volumes and movements of people into Australia.
In 2020, arrivals into Australia decreased by >95%. Antibiotic community use fell by >20%. There were sharp falls in trend rates of resistance for all antibiotics examined after restrictions were instituted. This fall in trend rates of resistance persisted during restrictions. Notably, trend rates of resistance fell in all three clinical contexts. After removal of restrictions, an upsurge in trend rates of resistance was seen for nearly all antibiotics but with no matching upsurge in antibiotic use.
Restricting the movement of people appeared to have a dramatic effect on resistance rates in The resulting reduced person-to-person interactions seems more closely associated with changes in antibiotic resistance than antibiotic usage patterns.
抗生素耐药性在全球范围内不断上升，是一个重大的“同一健康”问题。与抗生素使用相比，人际传播或“传染”在耐药菌株传播中所起的作用尚不清楚。作为应对新冠疫情的一部分，澳大利亚于2020年初实施了严格的人员流动限制措施。除了国内的封锁措施外，从海外进入澳大利亚的人员流动也受到严格限制。这些情况为研究人员流动与耐药率变化之间的关联提供了独特的机会。
对2016年至2023年期间超过64.6万份尿液分离株的月度耐药数据进行建模，以分析封锁前、封锁期间和封锁后耐药趋势的统计变化。数据涵盖三种临床环境（社区、医院和老年护理机构）。同时也有抗生素使用量和进入澳大利亚的人员流动数据。
2020年，进入澳大利亚的人数减少了95%以上。社区抗生素使用量下降了20%以上。在实施限制措施后，所有检测抗生素的耐药趋势率均大幅下降。这种耐药趋势率的下降在限制措施实施期间持续存在。值得注意的是，在所有三种临床环境中，耐药趋势率都有所下降。在解除限制后，几乎所有抗生素的耐药趋势率都出现了上升，但抗生素使用量并未相应增加。
限制人员流动似乎对澳大利亚的耐药率产生了显著影响。由此减少的人际互动似乎比抗生素使用模式更紧密地与抗生素耐药性变化相关。
