Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community
Open Access
- 19 January 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Antimicrobial Chemotherapy
- Vol. 66 (4), 928-935
- https://doi.org/10.1093/jac/dkq525
Abstract
To determine the temporal relationship between antibiotic use and incidence of antibiotic-resistant Escherichia coli in both the inpatient and outpatient setting of a large urban area. A retrospective observational time-series analysis was performed to evaluate the incidence of non-duplicate clinical isolates of E. coli resistant to ciprofloxacin, trimethoprim/sulfamethoxazole and cefepime from January 2000 through December 2007, combined with a transfer function model of aggregated data on antibiotic use in both settings obtained from the hospital's pharmacy and outpatient billing offices. Ciprofloxacin resistance increased from 6.0% (2000) to 15.4% (2007; P < 0.0001) and cefepime resistance from 0.9% (2002) to 3.2% (2007; P= 0.01). Trimethoprim/sulfamethoxazole resistance remained stable (23.7%–25.8%). Total antibiotic use increased in both settings, while fluoroquinolone use increased significantly only among outpatients. A temporal effect between fluoroquinolone resistance in community E. coli isolates and outpatient use of ciprofloxacin (immediate effect and time lag 1 month) and moxifloxacin (time lag 4 months) was observed, explaining 51% of the variance over time. The incidence of cefepime resistance in E. coli was correlated with ciprofloxacin use in the inpatient (lag 1 month) and outpatient (lag 4 months) settings and with the use of ceftriaxone (lag 0 month), piperacillin/tazobactam (3 months) and cefepime (3 months) in the hospital (R2 = 51%). These results support efforts to reduce prescribing of fluoroquinolones for control of resistant E. coli including extended-spectrum β-lactamase producers and show the added value of time-series analysis to better understand the interaction between community and hospital antibiotic prescribing and its spill-over effect on antibiotic resistance.Keywords
This publication has 39 references indexed in Scilit:
- The Prevalence of Fluoroquinolone Resistance Mechanisms in ColonizingEscherichia coliIsolates Recovered from Hospitalized PatientsClinical Infectious Diseases, 2010
- Antibiotic resistance and its cost: is it possible to reverse resistance?Nature Reviews Microbiology, 2010
- Significant Reduction of Antibiotic Use in the Community after a Nationwide Campaign in France, 2002–2007PLoS Medicine, 2009
- Plasmids Imparting Sulfonamide Resistance in Escherichia coli : Implications for PersistenceAntimicrobial Agents and Chemotherapy, 2009
- Consequences of increased antibacterial consumption and change in pattern of antibacterial use in Danish hospitalsJournal of Antimicrobial Chemotherapy, 2009
- Gastrointestinal Tract Colonization With Fluoroquinolone-Resistant Escherichia coli in Hospitalized Patients: Changes Over Time in Risk Factors for ResistanceInfection Control & Hospital Epidemiology, 2009
- Antimicrobial Drug Use and Resistance in EuropeEmerging Infectious Diseases, 2008
- Risk Factors for Trimethoprim-Sulfamethoxazole Resistance in Patients with Acute Uncomplicated CystitisAntimicrobial Agents and Chemotherapy, 2008
- European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in EuropeHeart, 2007
- Socioeconomic determinants of regional differences in outpatient antibiotic consumption: Evidence from SwitzerlandHealth Policy, 2006