Title: Policy-Relevant Determinants for the Control of Macrolide-Resistant Streptococcus Pneumoniae (MRSP): Do International Comparisons Help?
Author Name: Stephan Harbarth
Email:
Presenter Name: Stephan Harbarth
Authors: Harbarth S (1), Monnet DL (2), Pechère JC (3), Cars O (4)
Institution: (1) Geneva University Hospitals, Geneva; (2) Statens Serum Institut, Copenhagen; (3) International Society of Chemotherapy; Geneva; (4) STRAMA, Stockholm
Antimicrobial Agents And Surveillance Of Resistance (Stra
Problem Statement: Evaluating policy-relevant determinants of antibiotic overuse and bacterial resistance is a complex task. Standardized assessment of these determinants may enable cross-cultural comparisons, thus permitting policy makers to identify and implement those control measures that are most likely to be successful.
Objectives: The purpose of this retrospective ecologic study was to explore macro-level determinants explaining the large variation in the prevalence of MRSP in 14 European countries. Specifically, we attempted to test different hypotheses (e.g., antibiotic usage patterns, population characteristics, regulatory practices, socio-economic factors) linked to low or high MRSP prevalence.
Methods: An extensive list of all possible determinants that might explain variations in MRSP prevalence was established. Data on MRSP prevalence and explanatory factors were retrieved from electronic databases, reports from multinational and national surveillance systems, international organizations, and the European Commission. Correlations were assessed with the two-tailed Spearman coefficient for non-parametric correlations.
Results: MRSP prevalence in community-acquired respiratory tract infections varied from <5% (Germany, Sweden, Denmark, The Netherlands) to >40% (Italy, France). Outpatient macrolide use ranged from 0.8 (Sweden) to 5.7 daily defined doses/1,000 inhabitant-days (Spain). Total macrolide use and MRSP prevalence were highly correlated (r=0.88; p<0.001). Other determinants positively correlated with MRSP prevalence included use of broad-spectrum antibiotics (extended-spectrum penicillins, cephalosporins, fluoroquinolones); misuse of antibiotics (low compliance with antibiotic treatment, antibiotic self-medication); and factors facilitating cross-transmission of MRSP (attendance at preschool, foreign travel). Determinants negatively correlated with MRSP prevalence included protection against infectious diseases (breastfeeding, general vaccination coverage of infants, physical activity of adults); responsiveness of the health care system; and high use of narrow-spectrum penicillins. There was no correlation for several determinants that were presented as hypotheses to explain variations in MRSP prevalence such as high population density or low socio-economic status.
Conclusions: In this ecologic study, MRSP prevalence was significantly correlated with high use of macrolides and broad-spectrum antibiotics, and several other macro-level determinants in 14 European countries. Because of their strong correlation with MRSP prevalence, some of these determinants already appear as candidates for confirmatory studies at the individual patient level and as potential targets for interventions in countries with high prevalence of MRSP.
Study Funding: None