TY - JOUR
T1 - Exploring thresholds and interaction effects among antibiotic usage, covariates, and their effect on antibiotic resistance using an extended-spectrum β-Lactamase–producing Klebsiella pneumoniae case
AU - Aldeyab, Mamoon A.
AU - Al-Hashimy, Zainab Said
AU - Al-Yaqoobi, Mubarak
AU - Conway, Barbara R.
AU - Darwish Elhajji, Feras
AU - Bond, Stuart E.
AU - Lattyak, Elizabeth A.
AU - Hasan, Syed Shahzad
AU - Lattyak, William J.
N1 - Funding Information:
This paper was not funded.
Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Background: This study was aimed to explore thresholds with interaction effects among antibiotic usage, covariates (alcohol-based hand rub (ABHR)), and their effect on extended-spectrum β-lactamase–producing Klebsiella pneumoniae (ESBL-producing K. pneumoniae) in hospitalized patients. Methods: Multivariate Adaptive Regression Spline models were used. These considered second-order interactions among antibiotic use and ABHR in addition to potential thresholds that further improve explained variance in the ESBL-producing K. pneumoniae response. The study involved collecting monthly hospital-level data for January 2017–December 2021. Results: Analysis of the main effects showed that third-generation cephalosporins above 2.00 DDD/100 occupied bed days (OBD) generally increased ESBL-producing K. pneumoniae incidence (cases/100 OBD). Levels of ABHR above 6.61 L/100 OBD were shown to generally decrease ESBL-producing K. pneumoniae incidence. Second-order interactions revealed that when third-generation cephalosporin use was greater than 3.71 DDD/100 OBD, and ABHR was greater than 6.6 L/100 OBD (same as main effect threshold), ABHR partially lost effectiveness in its ability to reduce ESBL-producing K. pneumoniae incidence. This demonstrates the importance of not exceeding the identified thresholds of 3.71 DDD/100 OBD for third-generation cephalosporin use. Conclusion: The main-effect thresholds in third-generation cephalosporins and ABHR, and the identified interaction between third-generation cephalosporins and ABHR can inform effective hospital antimicrobial stewardship.
AB - Background: This study was aimed to explore thresholds with interaction effects among antibiotic usage, covariates (alcohol-based hand rub (ABHR)), and their effect on extended-spectrum β-lactamase–producing Klebsiella pneumoniae (ESBL-producing K. pneumoniae) in hospitalized patients. Methods: Multivariate Adaptive Regression Spline models were used. These considered second-order interactions among antibiotic use and ABHR in addition to potential thresholds that further improve explained variance in the ESBL-producing K. pneumoniae response. The study involved collecting monthly hospital-level data for January 2017–December 2021. Results: Analysis of the main effects showed that third-generation cephalosporins above 2.00 DDD/100 occupied bed days (OBD) generally increased ESBL-producing K. pneumoniae incidence (cases/100 OBD). Levels of ABHR above 6.61 L/100 OBD were shown to generally decrease ESBL-producing K. pneumoniae incidence. Second-order interactions revealed that when third-generation cephalosporin use was greater than 3.71 DDD/100 OBD, and ABHR was greater than 6.6 L/100 OBD (same as main effect threshold), ABHR partially lost effectiveness in its ability to reduce ESBL-producing K. pneumoniae incidence. This demonstrates the importance of not exceeding the identified thresholds of 3.71 DDD/100 OBD for third-generation cephalosporin use. Conclusion: The main-effect thresholds in third-generation cephalosporins and ABHR, and the identified interaction between third-generation cephalosporins and ABHR can inform effective hospital antimicrobial stewardship.
KW - antibiotic prescribing
KW - antibiotic resistance
KW - antibiotic stewardship
KW - Antibiotic use
KW - clinical practice
KW - ESBL-producing k. pneumoniae
KW - Threshold logistic modeling
KW - thresholds
UR - http://www.scopus.com/inward/record.url?scp=85163183086&partnerID=8YFLogxK
U2 - 10.1080/14787210.2023.2224961
DO - 10.1080/14787210.2023.2224961
M3 - Article
C2 - 37314366
AN - SCOPUS:85163183086
VL - 21
SP - 777
EP - 786
JO - Expert Review of Anti-Infective Therapy
JF - Expert Review of Anti-Infective Therapy
SN - 1478-7210
IS - 7
ER -