Epidemiological Interpretation of Studies Examining the Effect of Antibiotic Usage on Resistance

Schechner, Vered; Temkin, Elizabeth; Harbarth, Stéphan Juergen; Carmeli, Yehuda; Schwaber, Mitchell J.

doi:10.1128/cmr.00001-13

Cited by 161 publications

(174 citation statements)

References 190 publications

(158 reference statements)

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“…ince the advent of the first antimicrobials, antimicrobial-resistant bacteria (AMRB) have spread in conjunction with the use of the respective antimicrobial agents (1). Accordingly, the emergence of extended-spectrum ␤-lactamase (ESBL) enzymes as a global threat followed the introduction of third-generation cephalosporins (TGC), used mainly in health care settings (2).…”

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confidence: 99%

Prevalence, Risk Factors, and Transmission Dynamics of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae: a National Survey of Cattle Farms in Israel in 2013

et al. 2015

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b; Kimron Veterinary Institute, Beit Dagan, Israel c Our objectives were to study the prevalence, risk factors for carriage, and transmission dynamics of extended-spectrum-␤-lactamase (ESBL)-producing Enterobacteriaceae (ESBLPE) in a national survey of cattle. This was a point prevalence study conducted from July to October 2013 in Israel. Stool samples were collected from 1,226 cows in 123 sections on 40 farms of all production types. ESBLPE were identified in 291 samples (23.7%): 287 contained Escherichia coli and 4 contained Klebsiella pneumoniae. The number of ESBLPE-positive cows was the highest in quarantine stations and on fattening farms and was the lowest on pasture farms (P ‫؍‬ 0.03). The number of ESBLPE-positive cows was the lowest in sections containing adult cows (age, >25 months) and highest in sections containing calves (age, <4 months) (P < 0.001). Infrastructure variables that were significant risk factors for ESBLPE carriage included crowding, a lack of manure cleaning, and a lack of a cooling (P < 0.001 for each), all of which were more common in sections containing calves. Antimicrobial prophylaxis was given almost exclusively to calves and was associated with a high number of ESBLPE carriers (P < 0.001). The 287 E. coli isolates were typed into 106 repetitive extragenic palindromic (REP)-PCR types and mostly harbored bla CTX-M-1 or bla CTX-M-9 group genes. The isolates on the six farms with >15 isolates of ESBLPE were of 4 to 7 different REP-PCR types, with one dominant type being harbored by about half of the isolates. Fourteen types were identified on more than one farm, with only six of the farms being adjacent to each other. The prevalence of ESBLPE carriage is high in calves in cowsheds where the use of antimicrobial prophylaxis is common. ESBLPE disseminate within cowsheds mainly by clonal spread, with limited intercowshed transmission occurring. Since the advent of the first antimicrobials, antimicrobial-resistant bacteria (AMRB) have spread in conjunction with the use of the respective antimicrobial agents (1). Accordingly, the emergence of extended-spectrum ␤-lactamase (ESBL) enzymes as a global threat followed the introduction of third-generation cephalosporins (TGC), used mainly in health care settings (2). Although the ESBLs were first noted in the 1980s, a substantial increase in their prevalence in Escherichia coli was noted in the 2000s. This increase was mainly related to the emergence of a pandemic clone, designated sequence type (ST) 131. A particular worrisome feature of this clone was its predominance in community-onset cases of infection with ESBL-producing bacteria (3). This epidemiologic feature has attracted attention to the possibility of sources of acquisition other than health care settings, including the food and livestock industries. Indeed, many studies have documented the presence of ESBL-producing bacteria in a variety of meats and other livestock-origin food samples. Although the use of antimicrobials has often been suggested to be the main culprit for this ...

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Prevalence, Risk Factors, and Transmission Dynamics of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae: a National Survey of Cattle Farms in Israel in 2013

et al. 2015

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“…3,4,9,10,[26][27][28] These discrepancies might be related at least in part to different definitions of antimicrobial exposure and the possibility of uncontrolled confounders in retrospective studies. 29 In our study, the small number of patients who received each specific class of antibiotic limited our ability to find statistically significant associations. Exposure to carbapenems was marginally associated with an increased risk of CP-CRE acquisition; however, in a multivariate model, this exposure was not identified as an independent risk factor.…”

Section: Discussionmentioning

confidence: 90%

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.methods. A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.results. In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.conclusions. Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.

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“…The type of antibacterial prescribed was often incorrect because the prescribing was generally not consistent with the suspected pathogenic bacteria. 13,14 There are some efforts that can be done to control irrational drug use, including managerial, operational, and educational approaches. The managerial effort includes the application of strategy and policy which is basically aimed to increase the quality of prescribing, namely, rational prescribing.…”

Section: Discussionmentioning

confidence: 99%

The effect of the implementation of evidence-based drug formulary on antibacterial use in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia

et al. 2017

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The increase of drug expenditure in the hospital has facilitated the implementation of an evidence-based drug formulary. The aim of this study was to assess the change in antibacterial use after the implementation of an evidence-based drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia. This study used a preposttest design. Drug use data in the period before (2010-2011) and after (2012-2013) the formulary implementation were extracted from the hospital medical records. The drug use in the hospital before and after the implementation was compared using t-test and chi-square test, with the significance level of 0.05. Average number of drugs prescribed per prescription after the implementation was similar with that before the implementation (4.4 vs 4.6; p > 0.05). However, the proportion of generic drugs prescribed increased significantly after the formulary implementation (17.0% vs 52.7%; p < 0.05). Moreover, it was still significantly increased when the analysis was conducted only for antibacterial drugs (25.9% vs 72.0%; p < 0.05). Average drug cost per prescription was 34% lower after the intervention (p < 0.05), and the average cost for antibacterial drug was also decreased (26%). The use of antibacterial drugs was significantly decreased after the intervention (12.5% vs 6.9%; p < 0.05). The most often antibacterial drugs prescribed before the interventions were beta-lactams and macrolides; while quinolones were more increasingly used after the intervention. In conclusion, the implementation of evidencebased hospital drug formulary in a private hospital at Tanjung Enim, Sumatera Selatan significantly increase generic drug use and decreased antibacterial use and average drug cost per prescription. ABSTRAKPeningkatan belanja obat di rumah sakit menyebabkan dibuatnya formularium obat berbasis bukti. Tujuan dari penelitian ini adalah untuk menilai perubahan penggunaan antibakteri setelah implementasi formularium obat berbasis bukti di rumah sakit swasta di Tanjung Enim, Sumatera Selatan, Indonesia. Penelitian ini menggunakan rancangan prepost tes menggunakan data rekam medik rumah sakit dari periode sebelum (2010)(2011) 17 Kristin et al., The effect of the implementation of evidence-based drug formularyon antibacterial use in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesiadan setelah (2012-2013) implementasi formularium. Indikator penggunaan obat sebelum dan sesudah implementasi dibandingkan dengan menggunakan uji t dan chi square, dengan tingkat signifikansi 0,05. Jumlah rata-rata obat yang diresepkan perlembar resep sebelum dan setelah implementasi setara (4,4 vs 4,6; p > 0,05). Namun, proporsi obat generik yang diresepkan meningkat secara nyata setelah penerapan formularium (17,0 vs 52,7%; p <0,05). Selain itu peningkat secara nyata masih dijumpai ketika analisis dilakukan hanya untuk antibakteri (25,9 vs 72,0%; p <0,05). Rata-rata biaya obat per resep adalah 34% lebih rendah setelah implementasi (p <0,05) dan biaya rata-rata untuk antibakteri juga menurun ...

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Epidemiological Interpretation of Studies Examining the Effect of Antibiotic Usage on Resistance

Cited by 161 publications

References 190 publications

Prevalence, Risk Factors, and Transmission Dynamics of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae: a National Survey of Cattle Farms in Israel in 2013

Prevalence, Risk Factors, and Transmission Dynamics of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae: a National Survey of Cattle Farms in Israel in 2013

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

The effect of the implementation of evidence-based drug formulary on antibacterial use in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia

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