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Résistance bactérienne aux antibiotiques, apport du système national des données de santé

Abstract : The massive use of antibiotics in human and veterinary medicine has led to a significant increase of bacterial resistance to these drugs, making infections more difficult to treat. Antimicrobial resistance has become a major public health issue, which is why many action plan have been implemented at national and global scales. This thesis aims to analyze and measure the epidemiological and public health impacts of bacterial resistance to antibiotics based on the French national medico-administrative databases of health insurance (SNDS). First, an assessment of antimicrobial resistance in France was carried out. It was estimated that resistant bacteria caused 139 105 (95% CI 127 920–150 289) infections in 2016, resulting in a 12.3% (95% CI 11.3–13.2) resistance rate, and 2.52 hospitalizations for 1 000 patient-days. Then, risk factors for the acquisition resistant organisms were examined in the context of hospitalized urinary tract infections. A matched case-control analysis was conducted. This study point out the critical window of 3 months before the hospitalization of interest, the impact of broad-spectrum antibiotic consumption, urological procedures (of which prostate biopsy) and long intensive care unit stays on antibiotic resistance. Finally, the repercussion of antibiotic resistance were studied, by comparing the care pathways that follow bone and joint infections on prosthesis. A sequence analysis was conducted on a matched exposed-non exposed sample, and 6 typical care pathways were provided. Then, the use of a multinomial logistic regression allowed to compare the effect of resistance on care pathways.
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Submitted on : Tuesday, February 23, 2021 - 11:38:08 AM
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Marion Opatowski. Résistance bactérienne aux antibiotiques, apport du système national des données de santé. Médecine humaine et pathologie. Université Paris-Saclay, 2020. Français. ⟨NNT : 2020UPASR006⟩. ⟨tel-03149679⟩

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