美国抗生素耐药性对手术和癌症化疗抗生素预防的潜在负担：文献回顾和模型研究。

Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study.

机构信息

Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.

Center for Disease Dynamics, Economics & Policy, Washington, DC, USA.

出版信息

Lancet Infect Dis. 2015 Dec;15(12):1429-37. doi: 10.1016/S1473-3099(15)00270-4. Epub 2015 Oct 22.

DOI:10.1016/S1473-3099(15)00270-4

PMID:26482597

Abstract

BACKGROUND

The declining efficacy of existing antibiotics potentially jeopardises outcomes in patients undergoing medical procedures. We investigated the potential consequences of increases in antibiotic resistance on the ten most common surgical procedures and immunosuppressing cancer chemotherapies that rely on antibiotic prophylaxis in the USA.

METHODS

We searched the published scientific literature and identified meta-analyses and reviews of randomised controlled trials or quasi-randomised controlled trials (allocation done on the basis of a pseudo-random sequence-eg, odd/even hospital number or date of birth, alternation) to estimate the efficacy of antibiotic prophylaxis in preventing infections and infection-related deaths after surgical procedures and immunosuppressing cancer chemotherapy. We varied the identified effect sizes under different scenarios of reduction in the efficacy of antibiotic prophylaxis (10%, 30%, 70%, and 100% reductions) and estimated the additional number of infections and infection-related deaths per year in the USA for each scenario. We estimated the percentage of pathogens causing infections after these procedures that are resistant to standard prophylactic antibiotics in the USA.

FINDINGS

We estimate that between 38·7% and 50·9% of pathogens causing surgical site infections and 26·8% of pathogens causing infections after chemotherapy are resistant to standard prophylactic antibiotics in the USA. A 30% reduction in the efficacy of antibiotic prophylaxis for these procedures would result in 120,000 additional surgical site infections and infections after chemotherapy per year in the USA (ranging from 40,000 for a 10% reduction in efficacy to 280,000 for a 70% reduction in efficacy), and 6300 infection-related deaths (range: 2100 for a 10% reduction in efficacy, to 15,000 for a 70% reduction). We estimated that every year, 13,120 infections (42%) after prostate biopsy are attributable to resistance to fluoroquinolones in the USA.

INTERPRETATION

Increasing antibiotic resistance potentially threatens the safety and efficacy of surgical procedures and immunosuppressing chemotherapy. More data are needed to establish how antibiotic prophylaxis recommendations should be modified in the context of increasing rates of resistance.

FUNDING

DRIVE-AB Consortium.

摘要

背景

现有抗生素疗效下降可能危及接受医疗程序的患者的治疗效果。我们研究了美国十种最常见的手术程序和依赖抗生素预防的免疫抑制癌症化疗中抗生素耐药性增加的潜在后果。

方法

我们检索了已发表的科学文献，并确定了抗生素预防在预防手术和免疫抑制癌症化疗后感染和感染相关死亡方面的疗效的荟萃分析和随机对照试验或准随机对照试验的综述（分配基于伪随机序列，例如奇数/偶数医院号码或出生日期，交替）。我们在抗生素预防疗效降低的不同情况下（降低 10%、30%、70%和 100%）改变了确定的效果大小，并估计了美国每种情况下每年因感染和感染相关死亡的额外人数。我们估计了美国这些手术后导致感染的病原体中对标准预防抗生素耐药的比例。

发现

我们估计美国引起手术部位感染的病原体中有 38.7%至 50.9%，化疗后感染的病原体中有 26.8%对标准预防抗生素耐药。这些手术中抗生素预防效果降低 30%，将导致美国每年增加 12 万例手术部位感染和化疗后感染（从疗效降低 10%时的 4 万例到疗效降低 70%时的 28 万例），以及 6300 例感染相关死亡（范围：疗效降低 10%时为 2100 例，疗效降低 70%时为 15000 例）。我们估计，在美国，每年有 13120 例（42%）前列腺活检后感染归因于对氟喹诺酮类药物的耐药性。