背景:全国范围内关于耐碳青霉烯类肠杆菌(CREs)与抗生素使用之间关联的研究有限。
方法:这项嵌套病例对照研究分析了2017年4月至2019年4月的韩国国民健康保险索赔数据。基于CRE的发生,将≥18岁的住院患者分为CRE(病例)组和对照组。基于年龄的倾向得分,性别,修改后的Charlson合并症评分,保险类型,长期护理机构,重症监护室逗留,并使用耐万古霉素肠球菌的获取与病例组和对照组相匹配(1:3)。
结果:匹配后,该研究包括6,476名参与者(1,619例和4,857名对照).多因素logistic回归分析显示,广谱抗生素的使用,如哌拉西林/他唑巴坦(调整后的优势比[AOR],2.178;95%置信区间[CI],1.829-2.594),第三代/第四代头孢菌素(aOR,1.764;95%CI,1.514-2.056),和碳青霉烯类(aOR,1.775;95%CI,1.454-2.165),以及合并症的存在(糖尿病[aOR,1.237;95%CI,1.061-1.443],偏瘫或截瘫[aOR,1.370;95%CI,1.119-1.679],肾脏疾病[aOR,1.312;95%CI,1.105-1.559],和肝脏疾病[aOR,1.431;95%CI,1.073-1.908]),与CRE的发展显著相关。此外,CRE组的死亡率较高(8.33vs.3.32每100人-月发病率,P<0.001)和每人每月的医疗保健利用总成本(15,325,491±23,587,378vs.5,263,373±14,070,118韩元,P<0.001)高于对照组。
结论:广谱抗生素的使用和合并症的存在与CRE的发展增加有关。这项研究强调了抗菌药物管理在减少韩国广谱抗生素使用和CRE疾病负担方面的重要性。
BACKGROUND: Nationwide research on the association between carbapenem-resistant Enterobacterales (CREs) and antibiotic use is limited.
METHODS: This nested
case-control study analyzed Korean National Health Insurance claims data from April 2017 to April 2019. Based on the occurrence of CRE, hospitalized patients aged ≥ 18 years were classified into CRE (cases) and control groups. Propensity scores based on age, sex, modified Charlson comorbidity score, insurance type, long-term care facility, intensive care unit stay, and acquisition of vancomycin-resistant Enterococci were used to match the
case and control groups (1:3).
RESULTS: After matching, the study included 6,476 participants (1,619 cases and 4,857 controls). Multivariable logistic regression analysis revealed that the utilization of broad-spectrum antibiotics, such as piperacillin/tazobactam (adjusted odds ratio [aOR], 2.178; 95% confidence interval [CI], 1.829-2.594), third/fourth generation cephalosporins (aOR, 1.764; 95% CI, 1.514-2.056), and carbapenems (aOR, 1.775; 95% CI, 1.454-2.165), as well as the presence of comorbidities (diabetes [aOR, 1.237; 95% CI, 1.061-1.443], hemiplegia or paraplegia [aOR, 1.370; 95% CI, 1.119-1.679], kidney disease [aOR, 1.312; 95% CI, 1.105-1.559], and liver disease [aOR, 1.431; 95% CI, 1.073-1.908]), were significantly associated with the development of CRE. Additionally, the CRE group had higher mortality (8.33 vs. 3.32 incidence rate per 100 person-months, P < 0.001) and a total cost of healthcare utilization per person-month (15,325,491 ± 23,587,378 vs. 5,263,373 ± 14,070,118 KRW, P < 0.001) than the control group.
CONCLUSIONS: The utilization of broad-spectrum antibiotics and the presence of comorbidities are associated with increasing development of CRE. This study emphasizes the importance of antimicrobial stewardship in reducing broad-spectrum antibiotic use and CRE disease burden in Korea.