The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings

Mamoon A. Aldeyab, Stephan Harbarth, Nathalie Vernaz, Mary P. Kearney, Michael G. Scott, Feras W. Darwish Elhajji, Motasem A. Aldiab, James C. Mcelnay

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Aims: The objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates. METHODS: The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009). Results: Analysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P= 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P= 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P= 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P < 0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P= 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P < 0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates. Discussion: This study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship.

LanguageEnglish
Pages171-179
Number of pages9
JournalBritish Journal of Clinical Pharmacology
Volume74
Issue number1
DOIs
Publication statusPublished - 1 Jul 2012
Externally publishedYes

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beta-Lactamases
Fluoroquinolones
Primary Health Care
Anti-Bacterial Agents
Bacteria
Ciprofloxacin
Incidence
Amoxicillin-Potassium Clavulanate Combination
Retrospective Studies
Morbidity

Cite this

Aldeyab, Mamoon A. ; Harbarth, Stephan ; Vernaz, Nathalie ; Kearney, Mary P. ; Scott, Michael G. ; Darwish Elhajji, Feras W. ; Aldiab, Motasem A. ; Mcelnay, James C. / The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings. In: British Journal of Clinical Pharmacology. 2012 ; Vol. 74, No. 1. pp. 171-179.
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The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings. / Aldeyab, Mamoon A.; Harbarth, Stephan; Vernaz, Nathalie; Kearney, Mary P.; Scott, Michael G.; Darwish Elhajji, Feras W.; Aldiab, Motasem A.; Mcelnay, James C.

In: British Journal of Clinical Pharmacology, Vol. 74, No. 1, 01.07.2012, p. 171-179.

Research output: Contribution to journalArticle

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T1 - The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings

AU - Aldeyab, Mamoon A.

AU - Harbarth, Stephan

AU - Vernaz, Nathalie

AU - Kearney, Mary P.

AU - Scott, Michael G.

AU - Darwish Elhajji, Feras W.

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AU - Mcelnay, James C.

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