Abstract

Background

Antibiotic resistance poses a worldwide threat and knowledge concerning risk factors for colonization with multiresistant bacteria (MRB) is limited.

Objectives

To examine the impact of prior antibiotic consumption on MRB colonization, with focus on type of antibiotic and timeline between antibiotic prescription and MRB colonization.

Methods

A nationwide case–control study was conducted and adults visiting emergency departments were invited to participate. All patients were swabbed in the throat, nose and rectum, and analysed for colonization with ESBL-producing Enterobacteriaceae (ESBL-E), MRSA, carbapenemase-producing enterobacteria and VRE. Antibiotic history 2 years prior to enrolment was collected at an individual level through a national register. Multivariate analyses were performed to examine the association between antibiotic consumption and MRB status. A subgroup analysis of ESBL-E-colonized cases was made.

Results

We included 256 patients colonized with MRB and 4763 controls. In the 2 years prior to study inclusion, 77% of cases and 68% of controls had at least one antibiotic prescription (P = 0.002). We found a significant increase in risk of colonization with ESBL-E if penicillins (OR = 1.58–1.65) or fluoroquinolones (OR = 2.25–6.15) were prescribed. The analysis of all MRB-colonized patients showed similar results. An assessment of the timeline showed a significant increase in risk of colonization up to 2 years after exposure to penicillins, fluoroquinolones and macrolides.

Conclusions

The prevalence of ESBL-E colonization was related to fluoroquinolone, macrolide and penicillin consumption for at least 2 years after antibiotic treatment.

中文翻译：

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急性医院护理中多耐药细菌的定植：先前服用抗生素的相关性是一个危险因素。

摘要

背景

抗生素耐药性构成了世界范围的威胁，而关于多耐药细菌（MRB）定植的危险因素的知识是有限的。

目标

为了研究先前食用抗生素对MRB菌落的影响，重点是抗生素的种类以及抗生素处方和MRB菌落之间的时间线。

方法

进行了全国病例对照研究，并邀请访问急诊科的成年人参加。所有患者均被咽喉，鼻子和直肠擦拭，并用产生ESBL的肠杆菌科细菌（ESBL-E），MRSA，产生碳青霉烯酶的肠杆菌和VRE进行定植。入组前2年的抗生素治疗史是通过国家注册系统逐个收集的。进行多变量分析以检查抗生素消耗与MRB状态之间的关联。对ESBL-E定殖的病例进行了亚组分析。

结果

我们纳入了256例MRB定植的患者和4763例对照。在纳入研究的前2年中，有77％的病例和68％的对照具有至少一种抗生素处方（P =  0.002）。我们发现，如果开具青霉素（OR = 1.58–1.65）或氟喹诺酮类药物（OR = 2.25–6.15），则使用ESBL-E定植的风险会显着增加。对所有MRB殖民化患者的分析显示出相似的结果。对时间轴的评估显示，暴露于青霉素，氟喹诺酮和大环内酯类药物后长达2年的定植风险显着增加。

结论

抗生素治疗后至少2年，ESBL-E菌落的流行与氟喹诺酮，大环内酯和青霉素的消耗有关。