Abstract：
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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：评估抗菌药物对细菌的选择压力对于促进抗菌药物管理计划（ASP）很重要。这项研究的目的是通过评估抗生素的使用（碳青霉烯[CBP]和保留CBP的治疗）随着时间的推移以及使用多中心数据对CBP抗性生物的检测状态来评估抗生素的选择压力。
方法：在2017年至2020年在日本感染预防和医疗保健流行病学监测中注册的机构中，那些拥有使用CBP和CBP保留疗法（氟喹诺酮类药物[FQs]，头孢美唑[CMZ]，哌拉西林他唑巴坦[PIP/TAZ]，氨苄西林-舒巴坦[ABPC/SBT]，头孢曲松/头孢噻肟[CTRX/CTX]，CAZ(头孢他啶),头孢吡肟[CFPM]，和氨基糖苷类[AG]）以及对CBP耐药的肠杆菌（CRE）和CBP耐药的铜绿假单胞菌（CRPA）的检测。还分析了基于酒精的手摩擦（ABHR）的使用情况。回归分析，包括多元回归分析，进行了评估趋势。评估了抗菌药物使用密度（AUD）与CRE和CRPA检出率的相关性。
结果：在全国28个设施中，CBP,FQ,CAZ,AG,PIP/TAZ的使用量在3年内有所下降，而使用CMZ，ABPC/SBT,CTRX/CTX,CFPM,和ABHR以及CRE和CRPA检测率增加。平均AUD与CRE和CRPA检出率没有显着相关。多变量回归分析未显示每个AUD或ABHR与CRE或CRPA检测之间的任何显著相关性。
结论：CBP和ABHR的使用呈下降和上升趋势，分别,而CRPA和CRE检出率呈逐渐上升趋势。相当低的CRE和CRPA检测率表明，随着趋势的过度变化，可能已经观察到了数量上的微小差异。需要进一步研究以评估选择压力，同时考虑ASP的特征和抵抗的潜在机制。
方法：在2017年至2020年在日本感染预防和医疗保健流行病学监测中注册的机构中，那些拥有使用CBP和CBP保留疗法（氟喹诺酮类药物[FQs]，头孢美唑[CMZ]，哌拉西林他唑巴坦[PIP/TAZ]，氨苄西林-舒巴坦[ABPC/SBT]，头孢曲松/头孢噻肟[CTRX/CTX]，CAZ(头孢他啶),头孢吡肟[CFPM]，和氨基糖苷类[AG]）以及对CBP耐药的肠杆菌（CRE）和CBP耐药的铜绿假单胞菌（CRPA）的检测。还分析了基于酒精的手摩擦（ABHR）的使用情况。回归分析，包括多元回归分析，进行了评估趋势。评估了抗菌药物使用密度（AUD）与CRE和CRPA检出率的相关性。
结果：在全国28个设施中，CBP,FQ,CAZ,AG,PIP/TAZ的使用量在3年内有所下降，而使用CMZ，ABPC/SBT,CTRX/CTX,CFPM,和ABHR以及CRE和CRPA检测率增加。平均AUD与CRE和CRPA检出率没有显着相关。多变量回归分析未显示每个AUD或ABHR与CRE或CRPA检测之间的任何显著相关性。
结论：CBP和ABHR的使用呈下降和上升趋势，分别,而CRPA和CRE检出率呈逐渐上升趋势。相当低的CRE和CRPA检测率表明，随着趋势的过度变化，可能已经观察到了数量上的微小差异。需要进一步研究以评估选择压力，同时考虑ASP的特征和抵抗的潜在机制。
