Antibiotiku patēriņa un antibiotiku rezistences tendenču salīdzinājums starp Baltijas valstīm
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Latvijas Universitāte
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lav
Abstract
Antibiotikām rezistentas infekcijas ir kļuvušas par vienu no nopietnākajām 21. gadsimta sabiedrības veselības problēmām. Eiropas Savienība ir izvirzījusi vairākus epidemioloģiskos mērķus, lai AMR un uzlabotu racionālu antibiotiku lietošanu dalībvalstīs. Lai sasniegtu šos mērķus, ļoti svarīga ir AMR epidemioloģiskās situācijas un AMC uzraudzība. Mērķis bija noskaidrot, vai laika posmā no 2014. līdz 2023. gadam Baltijas valstīs pastāvēja būtiskas tendences un atšķirības antibiotiku lietošanā un pret antibiotikām rezistentu infekciju izplatībā. Tendenču analīzei tika izvēlētas trīs pret antibiotikām rezistentas baktērijas: MRSA, 3GC-rezistents E. coli un CRKP, jo tām ir noteikti konkrēti samazināšanas mērķi Eiropas Savienības līmenī. AMC tendences un atšķirības tika analizētas ambulatorajā, stacionārajā un kopējā aprūpes sektorā (ambulatorā un stacionārā aprūpe kopā). Šajā retrospektīvajā pētījumā tika analizēta AMR un AMC tendenču statistiskā nozīmība laikposmā no 2014. līdz 2023. gadam. Dati, kas tika izmantoti statistiskajai tendenču analīzei, tika iegūti no ECDC datubāzēm. Papildu dati tika iegūti no ECDC epidemioloģiskajiem pārskatiem. Laika posmā no 2014. līdz 2023. gadam Latvijā un Lietuvā tika novērotas statistiski nozīmīgas MRSA un 3GC-rezistentu E. coli izolātu pieauguma tendences, neskatoties uz samazinājumu COVID-19 pandēmijas laikā. Latvijā un Lietuvā tika konstatētas arī statistiski nozīmīgas 3GC-rezistentu E. coli pozitīvo izolātu procentu pieauguma tendences. Visās Baltijas valstīs tika novērotas statistiski nozīmīgas CRKP pozitīvo izolātu un to pozitīvo procentu pieauguma tendences. Kopējā un ambulatorā sektora antibiotiku patēriņa tendences nevienā no Baltijas valstīm nebija statistiski nozīmīgas, iespējams, saistībā ar būtisku antibiotiku lietošanas samazinājumu COVID-19 pandēmijas laikā. Tikai Latvijā tika konstatēta statistiski nozīmīga AMC samazinājuma tendence stacionārajā sektorā laika posmā no 2014. līdz 2023. gadam. Stacionārais sektors antibiotiku patēriņa ziņā bija vairāk ietekmēts pandēmijas laikā nekā ambulatorais sektors. Kopējais AMC būtiski atšķīrās starp Baltijas valstīm 2014.–2023. gadā: Lietuvā antibiotiku patēriņš bija visaugstākais, Igaunijā, viszemākais, bet Latvijā, vidējs. Latvija un Lietuva konsekventi sasniedza ES izvirzīto mērķi, vismaz 65 % no izmantotajām antibiotikām ir no “Access” AWaRe grupas, kamēr Igaunija līdz šim šo mērķi nav sasniegusi. 3GC-rezistentu E. coli un CRKP pieauguma tendences Baltijas valstīs, īpaši Latvijā un Lietuvā, ir satraucošas. COVID-19 pandēmijas laikā visās trijās valstīs tika novērotas negatīvas tendences visām baktērijām, izņemot CRKP, kuras izplatība Latvijā un Igaunijā turpināja pieaugt arī pandēmijas laikā. Kopējā AMC netika konstatētas statistiski nozīmīgas tendences, izņemot statistiski nozīmīgu samazinājuma tendenci stacionārajā sektorā Latvijā. COVID-19 pandēmija izraisīja izteiktu, bet pārejošu kopējā AMC samazinājumu.
Antibiotic resistant infections have emerged as one of the most serious public health challenges to healthcare systems around the world in of the 21st century. The European union has made several epidemiological targets with the aim to reduce antibiotic resistance and improve prudent use of antibiotics in the member countries. Surveillance of the epidemiological situation of AMR and antibiotic consumption are crucial to reach these targets. The aim was to find out if there were significant trends and differences in the use of antibiotics and the emergence of key antibiotic-resistant infections in the Baltic countries between 2014 and 2023. Three antibiotic resistant bacteria: MRSA, 3GC-resistant E. coli and CRKP were chosen for analysis of trends due to their existing concrete EU-level reduction targets. AMC trends and differences were assessed in the community, hospital and total care (community and hospital) sectors. In this retrospective study the statistical significance of AMR and AMC trends were analysed between 2014 and 2023. Data used for statistical analysis of trends was obtained from ECDC databases. Additional data was found from ECDC epidemiological reports. There were significant increasing trends for MRSA and 3GC-resistant E. coli isolates in Latvia and Lithuania, between 2014 and 2023, despite decreases during the COVID-19 pandemic. Significant increasing trends for percentages of positive 3GC-resistant E. coli isolates in Latvia and Lithuania were found. There were also significant increasing trends for CRKP positive isolates and their positive percentages in all Baltic countries. Trends of total antibiotic consumption in total and community sectors were not significant in any Baltic country, likely due to the significant decrease of antibiotic use during the COVID-19 pandemic. Only Latvia saw a significant decreasing trend in hospital sector AMC between 2014 and 2023. AMC in the hospital sector was more affected by the pandemic than in the community sector. Total AMC was significantly different between the Baltic countries between 2014 and 2023: Lithuania had the highest antibiotic usage, Estonia had the lowest usage, and Latvia had intermediate usage. Latvia and Lithuania consistently reach the EU target of 65% antibiotic usage being from the Access AWaRe group, while Estonia falls short of this target so far. The increasing trends for 3GC-resistant E. coli and CRKP are concerning in the Baltic countries, especially in Latvia and Lithuania. Negative trends are observed for all bacteria during the COVID-19 pandemic in all three countries, except for CRKP that continued to increase during the pandemic in Latvia and Estonia. No significant trends were found in total AMC, except a significant decreasing trend in the hospital sector in Latvia. The COVID-19 pandemic caused large a negative but transient trend in total AMC. Large differences were observed for AMC between the Baltic countries, especially in the hospital sector.
Antibiotic resistant infections have emerged as one of the most serious public health challenges to healthcare systems around the world in of the 21st century. The European union has made several epidemiological targets with the aim to reduce antibiotic resistance and improve prudent use of antibiotics in the member countries. Surveillance of the epidemiological situation of AMR and antibiotic consumption are crucial to reach these targets. The aim was to find out if there were significant trends and differences in the use of antibiotics and the emergence of key antibiotic-resistant infections in the Baltic countries between 2014 and 2023. Three antibiotic resistant bacteria: MRSA, 3GC-resistant E. coli and CRKP were chosen for analysis of trends due to their existing concrete EU-level reduction targets. AMC trends and differences were assessed in the community, hospital and total care (community and hospital) sectors. In this retrospective study the statistical significance of AMR and AMC trends were analysed between 2014 and 2023. Data used for statistical analysis of trends was obtained from ECDC databases. Additional data was found from ECDC epidemiological reports. There were significant increasing trends for MRSA and 3GC-resistant E. coli isolates in Latvia and Lithuania, between 2014 and 2023, despite decreases during the COVID-19 pandemic. Significant increasing trends for percentages of positive 3GC-resistant E. coli isolates in Latvia and Lithuania were found. There were also significant increasing trends for CRKP positive isolates and their positive percentages in all Baltic countries. Trends of total antibiotic consumption in total and community sectors were not significant in any Baltic country, likely due to the significant decrease of antibiotic use during the COVID-19 pandemic. Only Latvia saw a significant decreasing trend in hospital sector AMC between 2014 and 2023. AMC in the hospital sector was more affected by the pandemic than in the community sector. Total AMC was significantly different between the Baltic countries between 2014 and 2023: Lithuania had the highest antibiotic usage, Estonia had the lowest usage, and Latvia had intermediate usage. Latvia and Lithuania consistently reach the EU target of 65% antibiotic usage being from the Access AWaRe group, while Estonia falls short of this target so far. The increasing trends for 3GC-resistant E. coli and CRKP are concerning in the Baltic countries, especially in Latvia and Lithuania. Negative trends are observed for all bacteria during the COVID-19 pandemic in all three countries, except for CRKP that continued to increase during the pandemic in Latvia and Estonia. No significant trends were found in total AMC, except a significant decreasing trend in the hospital sector in Latvia. The COVID-19 pandemic caused large a negative but transient trend in total AMC. Large differences were observed for AMC between the Baltic countries, especially in the hospital sector.