Antibiotic use and population ecology: How you can reduce your "resistance footprint"

Patrick, David M.; Hutchinson, James

doi:10.1503/cmaj.080626

Cited by 47 publications

(38 citation statements)

References 49 publications

(53 reference statements)

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“…24 In our ED, ciprofloxacin was the most commonly prescribed antibiotic for uncomplicated cystitis during our study period, accounting for 52.7% of prescriptions (data not shown). This may not be wise, and, when possible, preference should be given to nonfluoroquinolone alternatives, such as nitrofurantoin (see Table 5).…”

mentioning

confidence: 70%

“…Resistance to ciprofloxacin occurred in 14.7% of the sample, whereas resistance to trimethoprim-sulfamethoxazole (TMP-SMX) occurred in 27.5%. For uncomplicated cystitis, 24.0% of urine cultures demonstrated resistance to TMP-SMX, 9.5% to ciprofloxacin, and 6.8% to both antibiotics (data not shown). For uncomplicated PN, the rate of resistance was 36.8% for TMP-SMX, 19.5% for ciprofloxacin, and 13.8% for both antibiotics.…”

Section: Urine Culture and Sensitivitiesmentioning

confidence: 95%

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Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

Filiatrault

McKay

Patrick

et al. 2012

CJEM

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Introduction: We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance. Methods: We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated. Results: Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases. Escherichia coli accounted for 82.3% of all UTIs, whereas Staphylococcus saprophyticus accounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16-9.62) and TMP-SMX (OR 4.02, 95% CI 1.48-10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance. Conclusions: E. coli was the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.

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mentioning

confidence: 70%

Section: Urine Culture and Sensitivitiesmentioning

confidence: 95%

Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

Filiatrault

McKay

Patrick

et al. 2012

CJEM

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“…Overuse of antibiotics has been implicated in the rapid surge in drug-resistant organisms, and yet our response is to use more and more sophisticated antibiotics as front-line agents to treat relatively benign entities like soft tissue abscesses. A recent CMAJ editorial on this topic 12 again asks us to reduce our "antibiotic footprint," and the management of soft tissue abscesses is a good place to start. We know that emergency physicians and EDs are at the front line for identification of infectious diseases.…”

Section: What Are My Colleagues Doing?mentioning

confidence: 99%

MRSA – happy and thriving in Canada. What’s an emergency doctor supposed to do?

Murray

2009

CJEM

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“…1 Only 6%-18% of children with acute respiratory infections, 5%-15% of adults with pharyngitis and 38% of adults with acute rhinosinusitis have bacterial infections. 3,4 Studies investigating improvement in clinical decision-making about the use of antibiotics for acute respiratory infections have been inconclusive, and interventions to reduce their use have shown only moderate success.…”

mentioning

confidence: 99%

Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial

Légaré

Labrecque

Cauchon

et al. 2012

CMAJ

179

189

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D espite recent efforts to decrease the use of antibiotics for acute respiratory infections, their prescription is still too frequent 1,2 and may be contributing to antibiotic resistance. 1 Only 6%-18% of children with acute respiratory infections, 5%-15% of adults with pharyngitis and 38% of adults with acute rhinosinusitis have bacterial infections. 3,4 Studies investigating improvement in clinical decision-making about the use of antibiotics for acute respiratory infections have been inconclusive, and interventions to reduce their use have shown only moderate success. 5 In the shared decision-making model, a health care professional and the patient make a decision together based on the best available evidence and the patient's values and preferences. 6 Shared decision-making is recognized as an effective strategy for reducing the overuse of treatment options not clearly associated with benefits for all patients. 7 In a randomized pilot trial, we showed that an earlier version of the training program in shared decision-making (DECISION+) reduced the proportion of patients who decided to use antibiotics immediately after consulting for acute respiratory infections (control 49%, DECISION+ 33%; absolute difference 16%; p = 0.08), a reduction that was maintained 6 months later. 8 However, because only 46% of enrolled providers in the pilot trial participated in all three 3-hour workshops, we improved the training program before conducting a definitive trial. 9 Following an in-depth evaluation with participants in the pilot trial, 10,11 we modified the training program and renamed it DECISION+2. In the current study, we evaluated its effect on the proportion of patients who decided to use antibiotics for acute respiratory infections after physician consultation. Background: Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections. We evaluated the effect of DECISION+2, a shared decision-making training program, on the percentage of patients who decided to take antibiotics after consultation with a physician or resident.

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Antibiotic use and population ecology: How you can reduce your "resistance footprint"

Cited by 47 publications

References 49 publications

Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department

MRSA – happy and thriving in Canada. What’s an emergency doctor supposed to do?

Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial

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