以个人医保数据中前几个月的抗生素使用情况为工具，预测尿路感染的细菌耐药性：前瞻性队列研究。

IF 2.9 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now Pub Date : 2024-06-25 DOI:10.1016/j.idnow.2024.104942

Kévin Alexandre , André Gillibert , Sandrine Dahyot , Roland Fabre , Francis Kuhn , Jacques Benichou , Valérie Delbos , François Caron

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引用次数: 0

摘要

目的：我们旨在根据社区获得性大肠埃希菌尿路感染（UTI）患者在过去18个月中的抗生素暴露情况，量化他们个人的抗菌药耐药性风险：2015-2017年，两个中心对法国患者进行了前瞻性招募。根据医保档案中记录的既往类内和类间抗生素暴露情况，分析分离菌株对阿莫西林（AMX）、阿莫西林-克拉维酸（AMC）、第三代头孢菌素（3GC）、三甲双氨-磺胺甲噁唑（TMP-SMX）、氟喹诺酮类（FQ）和磷霉素（FOS）的耐药性：在分析的 722 例尿毒症患者（564 例）中，有 588 例（81.4%）曾接触过抗生素。与远期接触（UTI 前 18 个月）相比，近期接触（UTI 前 3 个月）AMX、AMC、FQ 和 TMP-SMX 对大肠杆菌耐药性的影响更大，调整后的几率比[95% 置信区间]分别为 1.63 [1.20-2.21]、1.59 [1.02-2.48]、3.01 [1.90-4.77]和 2.60 [1.75-3.87]。AMX、FQ和TMP-SMX也显示出显著的类间影响。对 3GC 的耐药性与类内暴露无明显关联（调整 OR：0.88 [0.41-1.90]）。对 FOS 的耐药性非常低（0.4%）。AMX和TMP-SMX的无抗生素期为18个月，而AMC（5.2个月[2.3至>18个月]）和FQ（17.4个月[7.4至>18个月]）的无抗生素期则不确定：结论：导致UTI的大肠杆菌的耐药性可通过之前个人使用抗生素的情况进行部分预测。

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Individual health insurance data of antibiotic delivery in previous months as a tool to predict bacterial resistance of urinary tract infection: A prospective cohort study

Objectives

We aimed to quantify the individual risk of antimicrobial resistance among patients with community-acquired Escherichia coli urinary tract infection (UTI) according to their antibiotic exposure over the previous 18 months.

Patients and methods

French patients were prospectively recruited in two centers in 2015–2017. Resistance of isolates to amoxicillin (AMX), amoxicillin-clavulanate (AMC), third-generation cephalosporins (3GC), trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQ) and fosfomycin (FOS) was analysed according to previous intra-class and inter-class antibiotic exposure documented in health insurance files.

Results

Previous antibiotic exposure was found in 588 (81.4 %) of the 722 UTI cases analysed (564 patients). Recent exposure (three months before UTI) was associated with stronger intra-class impact on E. coli resistance compared to remote exposure (18 months before UTI) for AMX, AMC, FQ and TMP-SMX, with respective adjusted odds ratios [95 % confidence interval] of 1.63 [1.20–2.21], 1.59 [1.02–2.48], 3.01 [1.90–4.77], and 2.60 [1.75–3.87]. AMX, FQ, and TMP-SMX also showed significant inter-class impact. Resistance to 3GC was not significantly associated with intraclass exposure (adjusted OR: 0.88 [0.41–1.90]). FOS resistance was remarkably low (0.4 %). Duration of the antibiotic-free period required for resistance risk to drop below 10 %, the threshold for empirical use in UTI, was modelled as < 1 month for 3GC, >18 months for AMX and TMP-SMX and uncertain for AMC (5.2 months [2.3 to > 18]) and FQ (17.4 months [7.4 to > 18]).