利用多中心半自动监控系统评估抗菌素选择性压力 日本感染预防和医疗保健流行病学监控系统

IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES
Kayoko Hayakawa , Yusuke Asai , Taichi Tajima , Mio Endo , Jun Kawabata , Naoki Fujii , Mikiyo Sakaguchi , Haruhiko Ishioka , Shinya Tsuzuki , Nobuaki Matsunaga , Norio Ohmagari , Haruhisa Fukuda
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引用次数: 0

摘要

背景评估抗菌药物对细菌的选择性压力对于促进抗菌药物管理计划(ASP)非常重要。本研究旨在利用多中心数据,通过评估抗菌药物的使用(碳青霉烯类 [CBP] 和碳青霉烯类保留疗法)随时间推移的变化情况以及碳青霉烯类耐药菌的检测情况,来评估抗菌药物的选择性压力。方法在 2017 年至 2020 年日本感染预防和医疗流行病学监测中登记了数据的医疗机构中,有 CBP 和 CBP 辅助疗法(氟喹诺酮类[FQs]、头孢美唑[CMZ]、哌拉西林-他唑巴比妥[CMZ]、喹诺酮类[FQs]、头孢美唑[CMZ])使用情况数据的医疗机构,将其作为一个研究对象、哌拉西林-他唑巴坦[PIP/TAZ]、氨苄西林-舒巴坦[ABPC/SBT]、头孢曲松/头孢他啶[CTRX/CTX]、CAZ(头孢他啶)、头孢吡肟[CFPM]和氨基糖苷类药物[AGs])的使用数据以及耐 CBP 肠杆菌(CRE)和耐 CBP 铜绿假单胞菌(CRPA)的检测数据。还分析了酒精擦手(ABHR)的使用情况。为评估趋势进行了回归分析,包括多变量回归分析。结果 在全国 28 家医疗机构中,CBP、FQ、CAZ、AG 和 PIP/TAZ 的使用量在 3 年内有所下降,而 CMZ、ABPC/SBT、CTRX/CTX、CFPM 和 ABHR 的使用量以及 CRE 和 CRPA 的检出率则有所上升。平均 AUD 与 CRE 和 CRPA 的检出率无明显相关性。多变量回归分析未显示每种 AUD 或 ABHR 与 CRE 或 CRPA 检出率之间存在明显相关性。CRE和CRPA的检出率相当低,这表明随着趋势的过度变化,可能会观察到数量上的细微差别。在考虑 ASP 特性和抗药性机制的同时,有必要开展进一步调查,以评估选择性压力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of antimicrobial selective pressure using the multicenter semiautomatic surveillance system Japan surveillance for infection prevention and healthcare epidemiology

Background

Evaluating the selective pressure of antimicrobials on bacteria is important for promoting antimicrobial stewardship programs (ASPs). The aim of this study was to assess the selective pressure of antimicrobials by evaluating their use (carbapenem [CBP] and CBP-sparing therapy) over time and the detection status of CBP-resistant organisms using multicenter data.

Methods

Among the facilities whose data were registered in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology from 2017 to 2020, those that had data on the use of CBP and CBP-sparing therapy (fluoroquinolones [FQs], cefmetazole [CMZ], piperacillin–tazobactam [PIP/TAZ], ampicillin–sulbactam [ABPC/SBT], ceftriaxone/cefotaxime [CTRX/CTX], CAZ (ceftazidime), cefepime [CFPM], and aminoglycosides [AGs]) as well as on CBP-resistant Enterobacterales (CRE) and CBP-resistant Pseudomonas aeruginosa (CRPA) detection were included. Alcohol-based hand rubbing (ABHR) usage was also analyzed. Regression analyses, including multivariable regression analysis, were performed to evaluate trends. The association of antimicrobial use density (AUD) with CRE and CRPA detection rates was evaluated.

Results

In 28 facilities nationwide, CBP, FQ, CAZ, AG, and PIP/TAZ use decreased over the 3-year period, whereas the use of CMZ, ABPC/SBT, CTRX/CTX, CFPM, and ABHR as well as the rates of CRE and CRPA detection increased. The average AUD did not significantly correlate with CRE and CRPA detection rates. The multivariable regression analysis did not reveal any significant correlation between each AUD or ABHR and CRE or CRPA detection.

Conclusion

CBP and ABHR use showed a decreasing and an increasing trend, respectively, while CRPA and CRE detection rates exhibited a gradual increase. The considerably low CRE and CRPA detection rates suggest that slight differences in numbers may have been observed as excessive trend changes. Further investigation is warranted to evaluate selective pressure while considering the characteristics of ASP and the mechanisms underlying resistance.

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来源期刊
Journal of Infection and Public Health
Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
13.10
自引率
1.50%
发文量
203
审稿时长
96 days
期刊介绍: The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.
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