Primary care treatment guidelines for skin infections in Europe: congruence with antimicrobial resistance found in commensal Staphylococcus aureus in the community

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• 作者：Evelien ME van Bijnen (1)
  W John Paget (1)
  Casper DJ den Heijer (2)
  Ellen E Stobberingh (2)
  Cathrien A Bruggeman (2)
  Fran莽ois G Schellevis (1) (3)
  in collaboration with the APRES Study Team
  
  1. Netherlands Institute for Health Services Research (NIVEL) ; Otterstraat 118-124 ; Utrecht ; The Netherlands
  2. Department of Medical Microbiology/School for Public Health and Primary Care (CAPHRI) ; Maastricht University Medical Centre ; P. Debyelaan 25 ; Maastricht ; The Netherlands
  3. Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research ; VU University Medical Centre ; De Boelelaan 1117 ; Amsterdam ; The Netherlands
  
• 关键词：Antibiotic resistance ; Treatment guidelines ; Primary care ; Skin infections
• 刊名：BMC Family Practice
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：15
• 期：1
• 全文大小：225 KB
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• 刊物主题：General Practice / Family Medicine; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1471-2296

文摘

Background Over 90% of antibiotics for human use in Europe are prescribed in primary care. We assessed the congruence between primary care treatment guidelines for skin infections and commensal Staphylococcus aureus (S. aureus) antimicrobial resistance levels in community-dwelling persons. Methods The prevalence of antimicrobial resistance in S. aureus was analysed by taking nose swabs from healthy primary care patients in nine European countries (total N = 32,032). Primary care treatment guidelines for bacterial skin infections were interpreted with respect to these antimicrobial resistance patterns. First- and second-choice recommendations were assessed and considered congruent if resistance to the antibiotic did not exceed 20%. Results We included primary care treatment guidelines for impetigo, cellulitis, folliculitis and furuncle. Treatment recommendations in all countries were consistent: most of the first-choice recommendations were beta-lactams, both for children and adults. Antimicrobial resistance levels were low, except for penicillin (on average 73% resistance). Considerable variation in antimicrobial resistance levels was found between countries, with Sweden displaying the lowest levels and Spain the highest. In some countries resistance to penicillin and azithromycin was significantly higher in children (4-17 years) compared with adults. Conclusions Most of the first- and second-choice recommendations in the treatment guidelines for skin infections were congruent with commensal S. aureus antimicrobial resistance patterns in the community, except for two recommendations for penicillin. Given the variation in antimicrobial resistance levels between countries, age groups and health care settings, national data regarding antimicrobial resistance in the community should be taken into account when updating or developing primary care treatment guidelines.