Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Vihta, Karina-Doris; Stoesser, Nicole; Llewelyn, Martin J.; Quan, T Phuong; Davies, T.G.; Fawcett, Nicola; Dunn, Laura; Jeffery, Katie; Butler, Christopher Collett; Hayward, Gail; Andersson, Monique; Morgan, Marcus; Oakley, Sarah; Mason, Amy M.; Hopkins, Susan; Wyllie, David; Crook, Derrick W.; Wilcox, Mark H.; Johnson, Alan P.; Peto, Tim E. A.; Walker, A Sarah

doi:10.1016/s1473-3099(18)30353-0

Cited by 129 publications

(117 citation statements)

References 30 publications

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“…Levels of E. coli and Klebsiella-associated bacteremia were continuing to rise in England after 2006 while reduction in fluoroquinolone and cephalosporin use was taking place [18,41]. Amoxicillin-clavulanate prescribing in England increased significantly between 2006-2011 [42], and incidence of bacteremia with E. coli strains resistant to co-amoxiclav began to increase rapidly after 2006 ( [43], Figure 4), with co-amoxiclav resistance in E. coli bacteremia exceeding 40% in 2014 [40]. Those findings from the UK suggest that data on resistance patterns for different antibiotics in different bacteria contributing to various syndromes should be considered when new antibiotic prescribing practices (such as the increase in the use of penicillins in England accompanying the decrease in the use of fluoroquinolones and cephalosporins) are being phased in.…”

Section: Discussionmentioning

confidence: 99%

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Goldstein

Olesen

Karaca

et al. 2018

Preprint

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Background: Rates of sepsis/septicemia hospitalization in the US have risen significantly during recent years, and antibiotic resistance and use may contribute to those rates through various mechanisms.Methods: We used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011-2012 to state-specific rates of hospitalization with septicemia (ICD-9 codes 038.xx present anywhere on discharge diagnosis) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85+y) reported to the Healthcare Cost and Utilization Project (HCUP) between 2011-2012, adjusting for additional covariates, and random effects associated with the ten US Health and Human Services (HHS) regions.Results: Rates of penicillin prescribing were positively associated with septicemia hospitalization rates in the analyses for persons aged 50-64y, 65-74y, and 74-84y. Percent African Americans in a given age group was positively associated with septicemia hospitalization rates in the analyses for persons aged 75-84y and over 85y. Average minimal daily temperature was positively associated with septicemia hospitalization rates in the analyses for persons aged 18-49y, 50-64y, 75-84y and over 85y. Conclusions: Our results suggest positive associations between the rates of prescribing for penicillins and the rates of sepsis hospitalization in US adults aged 50-84y. Further studies are needed to understand the potential effect of antibiotic replacement in the treatment of various syndromes, such as replacement of fluoroquinolones by other antibiotics, possibly penicillins following the recent US FDA guidelines on restriction of fluoroquinolone use, on the rates of sepsis hospitalization.

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Section: Discussionmentioning

confidence: 99%

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Goldstein

Olesen

Karaca

et al. 2018

Preprint

View full text Add to dashboard Cite

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“…Rates of prescribing of amoxicillin-clavulanate (co-amoxiclav) in England rose significantly between 2006-2011 [38], and so did the rates of bacteremia associated with E. coli strains resistant to co-amoxiclav ( [39,40]). In the US, prevalence of penicillin resistance in E. coliassociated urinary tract infections (UTIs) was found to be higher than the prevalence of fluoroquinolone resistance [16].…”

Section: Discussionmentioning

confidence: 99%

Outpatient prescribing of four major antibiotic classes and prevalence of antimicrobial resistance in US adults

Goldstein

et al. 2018

Preprint

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Background: There is limited information on the relation between antibiotic use and antibiotic resistance in the US.Methods: We used multivariable logistic regression to relate state-specific rates of outpatient prescribing overall for fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011-2014 to state-specific prevalence of resistance for select combinations of antibiotics/bacteria among catheter-associated urinary tract infections (CAUTIs) in the CDC Patient Safety Atlas data between 2011-2014 for adults aged 65+y and 19-64y, adjusting for potential confounders.Results: Rates of fluoroquinolone prescribing were positively associated with prevalence of fluoroquinolone resistance in Escherichia coli and Pseudomonas aeruginosa (both age groups), resistance to extended-spectrum (ES) cephalosporins in E. coli (aged 19-64y), and resistance to methicillin in Staphylococcus aureus (aged 19-64y). Rates of penicillin prescribing were positively associated with prevalence of resistance to fluoroquinolones in E. coli (aged 65+) and P. aeruginosa (both age groups), and resistance to ES cephalosporins in Klebsiella spp. (both age groups). Rates of cephalosporin prescribing were negatively associated with prevalence of resistance to fluoroquinolones in E. coli and resistance to ES cephalosporins in Klebsiella spp. (both age groups). Average annual temperature was positively associated with prevalence of resistance to ES cephalosporins in E. coli and P. aeruginosa, and resistance to fluoroquinolones in E. coli.Conclusions: Our results suggest that prescribing of fluoroquinolones and penicillins to US adults is associated with prevalence of antibiotic resistance, including ESBLs and MRSA.

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“…3 These differences are so large that increasing co-amoxiclav resistance was suggested to be primarily due to laboratories switching from US Clinical Laboratory Standards Institute (CLSI) to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. 4 Recent work, 5 however, suggests that changes in laboratory protocols are unlikely to account for the majority of the increase in resistance. Only one study has investigated whether there are underlying genetic causes for the ongoing rise in co-amoxiclav resistance, 6 but found no evidence of clonal expansion of any specific co-amoxiclav-resistant strains.…”

Section: Introductionmentioning

confidence: 99%

Reconciling the potentially irreconcilable? Genotypic and phenotypic amoxicillin-clavulanate resistance in Escherichia coli

Davies

Stoesser

Sheppard

et al. 2019

Preprint

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36Resistance to amoxicillin-clavulanate, a widely used beta-lactam/beta-lactamase inhibitor 37 combination antibiotic, is rising globally, yet susceptibility testing remains challenging. To test 38 whether whole-genome sequencing (WGS) could provide a more reliable assessment of 39 susceptibility than traditional methods, we predicted resistance from WGS for 976 E. coli 40 bloodstream infection isolates from Oxfordshire, UK, comparing against phenotypes from the 41 BD Phoenix (calibrated against EUCAST guidelines). 339/976 (35%) isolates were amoxicillin-42 clavulanate resistant. Predictions based solely on beta-lactamase presence/absence performed 43 poorly (sensitivity 23% (78/339)) but improved when genetic features associated with 44 penicillinase hyper-production (e.g. promoter mutations, copy number estimates) were 45 considered (sensitivity 82% (277/339); p<0.0001). Most discrepancies occurred in isolates with 46 peri-breakpoint MICs. We investigated two potential causes; the phenotypic reference and the 47 binary resistant/susceptible classification. We performed reference standard, replicated 48 phenotyping in a random stratified subsample of 261/976 (27%) isolates using agar dilution, 49 following both EUCAST and CLSI guidelines, which use different clavulanate concentrations. 50 As well as disagreeing with each other, neither agar dilution phenotype aligned perfectly with 51 genetic features. A random-effects model investigating associations between genetic features and 52 MICs showed that some genetic features had small, variable and additive effects, resulting in 53 variable resistance classification. Using model fixed-effects to predict MICs for the non-agar 54 dilution isolates, predicted MICs were in essential agreement (±1 doubling dilution) with 55 observed (BD Phoenix) MICs for 691/715 (97%) isolates. This suggests amoxicillin-clavulanate 56 resistance in E. coli is quantitative, rather than qualitative, explaining the poorly reproducible 57 4 binary (resistant/susceptible) phenotypes and suboptimal concordance between different 58 phenotypic methods and with WGS-based predictions. 59 60 61Rising amoxicillin-clavulanate resistance in E. coli is a major healthcare challenge, with 62 increasing incidence of resistant bloodstream infections (BSI)(1) threatening its utility as the 63 most commonly used antibiotic in Europe.(2) Consequently, many hospitals are considering 64 broadening their first-line empiric antibiotics for common infections. However, significant 65 uncertainty is created by observed differences between the two main assays for amoxicillin-66 clavulanate susceptibility in the classification of clinical samples.(3) These differences are so 67 large that increasing amoxicillin-clavulanate resistance was suggested to be primarily due to 68 laboratories switching from US Clinical Laboratory Standards Institute (CLSI) to European 69 Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.(4) Recent work,(5) 70 however, suggests that changes in laboratory protocols ar...

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Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998–2016: a study of electronic health records

Abstract: National Institute for Health Research.

Cited by 129 publications

References 30 publications

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states

Outpatient prescribing of four major antibiotic classes and prevalence of antimicrobial resistance in US adults

Reconciling the potentially irreconcilable? Genotypic and phenotypic amoxicillin-clavulanate resistance in Escherichia coli

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