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Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community

Vernaz, Nathalie ; Huttner, Benedikt ; Muscionico, Daniel ; Salomon, Jean-Luc ; Bonnabry, Pascal ; López-Lozano, José Maria ; Beyaert, Arielle ; Schrenzel, Jacques ; Harbarth, Stephan

In: Journal of Antimicrobial Chemotherapy, 2011, vol. 66, no. 4, p. 928-935

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    Titre
    • Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community
    Auteur
    • Vernaz, Nathalie. Pharmacy Department, University of Geneva Hospitals and Medical School, Geneva, Switzerland
    • Huttner, Benedikt. Infection Control Program, University of Geneva Hospitals and Medical School, Geneva, Switzerland
    • Muscionico, Daniel. OFAC, Invoice Office, Geneva, Switzerland
    • Salomon, Jean-Luc. OFAC, Invoice Office, Geneva, Switzerland
    • Bonnabry, Pascal. Pharmacy Department, University of Geneva Hospitals and Medical School, Geneva, Switzerland
    • López-Lozano, José Maria. Investigation Unit, Hospital Vega Baja, Orihuela, Alicante, Spain
    • Beyaert, Arielle. Department of Quantitative Methods for Economics and Business, University of Murcia, Murcia, Spain
    • Schrenzel, Jacques. Clinical Microbiology Laboratory, University of Geneva Hospitals and Medical School, Geneva, Switzerland
    • Harbarth, Stephan. Infection Control Program, University of Geneva Hospitals and Medical School, Geneva, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Journal of Antimicrobial Chemotherapy, 2011, vol. 66, no. 4, p. 928-935. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:291284
    Summary
    Objectives 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. Methods 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. Results 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%). Conclusions 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