Impact of Prior Antibiotic Use in Primary Care on Escherichia coli Resistance to Third Generation Cephalosporins: A Case-Control Study

Abstract

Research is lacking on the reversibility of antimicrobial resistance (AMR). Thus, we aimed to determine the influence of previous antibiotic use on the development and decay over time of third generation cephalosporin (3GC)-resistance of E. coli. Using the database of hospital laboratories of the Autonomous Province of Bolzano/Bozen (Italy), anonymously linked to the database of outpatient pharmaceutical prescriptions and the hospital discharge record database, this matched case-control study was conducted including as cases all those who have had a positive culture from any site for 3GC resistant E. coli (3GCREC) during a 2016 hospital stay. Data were analyzed by conditional logistic regression. 244 cases were matched to 1553 controls by the date of the first isolate. Male sex (OR 1.49, 95% CI 1.10–2.01), older age (OR 1.11, 95% CI 1.02–1.21), the number of different antibiotics taken in the previous five years (OR 1.20, 95% CI 1.08–1.33), at least one antibiotic prescription in the previous year (OR 1.92, 95% CI 1.36–2.71), and the diagnosis of diabetes (OR 1.57, 95% CI 1.08–2.30) were independent risk factors for 3GCREC colonization/infection. Patients who last received an antibiotic prescription two years or three to five years before hospitalization showed non-significant differences with controls (OR 0.97, 95% CI 0.68–1.38 and OR 0.85, 95% CI 0.59–1.24), compared to an OR of 1.92 (95% CI 1.36–2.71) in those receiving antibiotics in the year preceding hospitalization. The effect of previous antibiotic use on 3GC-resistance of E. coli is highest after greater cumulative exposure to any antibiotic as well as to 3GCs and in the first 12 months after antibiotics are taken and then decreases progressively.

Effect of Fluoroquinolone Use in Primary Care on the Development and Gradual Decay of Escherichia coli Resistance to Fluoroquinolones: A Matched Case-Control Study

“…In a previous study conducted in the Autonomous Province of Bolzano, located in northern Italy, we found that, over a five-year period, the risk of developing a community-acquired infection due to a third-generation cephalosporin-resistant (3GC) Escherichia coli increases significantly in patients who were previously exposed to antibiotics. The highest risk was observed when antibiotics were taken in the last 12 months and for greater cumulative exposures to any antibiotic, as well as to 3GC [ 11 ]. Improving our knowledge of the resistance decay of different bacterial species and after exposure to different antibiotics is critical to inform antibiotic stewardship interventions and clinical decisions with the aim of minimizing AMR worldwide [ 12 , 13 ].…”

Antibiotic exposure and acquisition of antibiotic-resistant gram-negative bacteria among outpatients at a US Veterans Affairs medical center

“…The emergence of antibiotic resistance in the outpatient setting has been reported as soon as 1 month after antibiotic exposure, and it can occur as much as 1 year after the index antibiotic prescription. 20,21 The emergence of antibiotic resistance in the outpatient setting is frequently associated with increased healthcare exposures, occurring within 90 days after inpatient admission and intravenous antibiotic treatment. 22,23 In contrast, this study characterizes a cohort of outpatients who acquired R-GNB and neither received antibiotics nor had healthcare exposure in the previous 90 days.…”

Use and quality of point-of-care microscopy, urine culture and susceptibility testing for urinalysis in general practice

“…A Danish study from 2017, investigating isolates from patients with suspected UTI in general practice, found that 45% of E. coli isolates to be resistant to at least one type of antibiotics commonly used in general practice [ 6 ]. Furthermore, a direct link between cumulative exposure to any antibiotic and the risk of developing a community-acquired infection due to third generation cephalosporin resistant E. coli was found in a recently published study [ 7 ]. The risk of developing an infection caused by resistant bacteria was highest during the first 12 months after exposure, with a decreasing trend over time, emphasising the possibility of resistant strains becoming susceptible again [ 7 ].…”

“…Furthermore, a direct link between cumulative exposure to any antibiotic and the risk of developing a community-acquired infection due to third generation cephalosporin resistant E. coli was found in a recently published study [ 7 ]. The risk of developing an infection caused by resistant bacteria was highest during the first 12 months after exposure, with a decreasing trend over time, emphasising the possibility of resistant strains becoming susceptible again [ 7 ]. In order to reduce the unnecessary use of antibiotics the World Health Organisation (WHO) has advised enhanced use of diagnostic tests [ 8 ].…”