频繁使用抗生素或增加感染住院风险
创作:兵兵 审核:兵兵 2020年03月11日
  • 研究纳入180万频繁使用抗生素的患者,由于感染并发症带来的最高住院率在开始使用抗生素不久后即出现;
  • 事先控制抗生素使用的患者,其由感染带来的住院率大幅度快速降低;
  • 而对于事先频繁服用抗生素的患者,其住院率在6个月后依然比较高;
  • 无并发症的患者中,最高与最低抗生素暴露人群相比,在处方药后3天、4-30天以及3-6个月的发病率比(IRR)分别为:1.18、1.44和3.22;
  • 抗生素的使用带来肠道菌群紊乱,可能造成抗药菌在体内的定殖。
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兵兵
文章基于人群大队列研究,发现频繁使用抗生素反而增加患者因感染住院风险。即使在无感染并发症人群中,抗生素的暴露也增加了其发病风险。研究认为,这种现象可能是由于抗生素造成患者体内菌群紊乱,造成抗药致病菌在体内的定殖,从而诱发机体感染发病。该研究结果呼吁谨慎使用抗生素。
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BMC Medicine [IF:8.775]

The effectiveness of frequent antibiotic use in reducing the risk of infection-related hospital admissions: results from two large population-based cohorts

频繁使用抗生素降低感染相关住院风险的有效性:两项基于人群的大队列研究结果

10.1186/s12916-020-1504-5

2020-03-02, Article

Abstract & Authors:展开

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Background: Previous research reported that individuals prescribed antibiotics frequently develop antimicrobial resistance. The objective of this study was to evaluate whether frequent antibiotic use is associated with reduced hospital admissions for infection-related complications.
Methods: Population-based cohort study analysing electronic health records from primary care linked to hospital admission records. The study population included patients prescribed a systemic antibiotic, recent record of selected infections and no history of chronic obstructive pulmonary disease. Propensity-matched cohorts were identified based on quintiles of prior antibiotic use in 3 years before.
Results: A total of 1.8 million patients were included. Repeated antibiotic use was frequent. The highest rates of hospital admissions for infection-related complications were observed shortly after antibiotic start in all prior exposure quintiles. For patients with limited prior antibiotic use, rates then dropped quickly and substantially. In contrast, reductions over time were substantially less in patients with frequent prior antibiotic use, with rates remaining elevated over the following 6 months. In patients without comorbidity comparing the highest to lowest prior exposure quintiles in the Clinical Practice Research Databank, the IRRs were 1.18 [95% CI 0.90–1.55] in the first 3 days after prescription, 1.44 [95% CI 1.14–1.81] in the days 4–30 after and 3.22 [95% CI 2.29–4.53] in the 3–6 months after.
Conclusions: Repeated courses of antibiotics, although common practice, may have limited benefit and indicator of adverse outcomes. A potential mechanism is that antibiotics may cause dysbiosis (perturbations of intestinal microbiota), contributing to colonization with resistant bacteria. Antibiotics should be used judiciously and only periodically unless indicated. Antimicrobial stewardship should include activities focusing on the substantive number of patients who repeatedly but intermittently get antibiotics.

First Authors:
Tjeerd Pieter van Staa

Correspondence Authors:
Tjeerd Pieter van Staa

All Authors:
Tjeerd Pieter van Staa,Victoria Palin,Yan Li,William Welfare,Timothy W Felton,Paul Dark,Darren M Ashcroft

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