Seasonal variation in antimicrobial resistance rates of community-acquired Escherichia coli bloodstream isolates

Ramsey, Elizabeth G.; Royer, Julie A.; Bookstaver, P. Brandon; Justo, Julie Ann; Kohn, Joseph; Albrecht, Helmut; Al-Hasan, Majdi N.

doi:10.1016/j.ijantimicag.2019.03.010

Cited by 21 publications

(29 citation statements)

References 35 publications

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“…24,25 These efforts are critical because seasonal variation in resistance rates has been associated with seasonality in ambulatory antibiotic prescriptions. 26,27 The finding of higher antibiotic prescription rate in rural settings is consistent with previous results. 23,[28][29][30] This finding may be partly due to concerns of patients' long travel distance and difficulty returning to care if symptoms persist, making watchful waiting less applicable.…”

Section: Discussionsupporting

confidence: 91%

Temporal trends in ambulatory antibiotic prescription rates in South Carolina: Impact of age, gender, and resident location

Winders

Royer²,

Younas

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: To examine the temporal trends in ambulatory antibiotic prescription fill rates and to determine the influences of age, gender, and location. Design: Population-based cohort study. Setting: Ambulatory setting in South Carolina. Patients: Patients ≤64 years of age from January 2012 to December 2017. Methods: Aggregated pharmacy claims data for oral antibiotic prescriptions were utilized to estimate community antibiotic prescription rates. Poisson regression or Student t tests were used to examine overall temporal trend in antibiotic prescription rates, seasonal variation, and the trends across age group, gender, and rural versus urban location. Results: Overall antibiotic prescription rates decrease from 1,127 to 897 per 1,000 person years (P < .001). The decrease was more noticeable in persons aged <18 years (26%) and 18–39 years (20%) than in those aged 40–64 years (5%; P < .001 for all). Prescription rates were higher among females than males in all age groups, although this finding was the most pronounced in group aged 18–39 years (1,232 vs 585 per 1,000 person years; P < .0001). Annualized antibiotic prescription rates were higher during the winter months (December–March) than the rest of the year (1,145 vs 885 per 1,000 person years; P < .0001), and rates were higher in rural areas than in urban areas (1,032 vs 941 per 1,000 person years; P < .0001). Conclusions: The decline in ambulatory antibiotic prescription rates is encouraging. Ongoing ambulatory antibiotic stewardship efforts across South Carolina should focus on older adults, rural areas, and during the winter season when antibiotic prescriptions peak.

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Section: Discussionsupporting

confidence: 91%

Temporal trends in ambulatory antibiotic prescription rates in South Carolina: Impact of age, gender, and resident location

Winders

Royer²,

Younas

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…The observed pattern for penicillins and macrolides—peak wintertime use followed by peaks in resistance in late winter to spring—was mostly consistent with previous findings 13,14,16 and with some theoretical predictions from models in which use drives resistance 21 . In S. aureus , use and resistance to oxacillin and erythromycin peaked in the winter, consistent with a previous seasonality study that compared macrolide use and resistance in methicillin-resistant S. aureus (MRSA) 14 , as well as findings in other species-antibiotic combinations that have shown winter peaks in use and resistance with little to no lag 13–15 . In E. coli , the first peaks in ampicillin and amoxicillin/clavulanate resistance occurred in the winter and spring, respectively, about 0.5 to 2.5 months after the peak in penicillins use.…”

Section: Discussionsupporting

confidence: 88%

“…Previous studies found that the antibiotic use-resistance relationship is detectable on a seasonal timescale, with positive associations in Streptococcus pneumoniae 13 , Escherichia coli 14,15 , Staphylococcus aureus 14 , and Neisseria gonorrhoeae 16 . However, these studies focused on the most highly prescribed antibiotic classes, such as β-lactams and macrolides, for which use peaks in the wintertime 17 .…”

Section: Introductionmentioning

confidence: 98%

Large variation in the association between seasonal antibiotic use and resistance across multiple bacterial species and antibiotic classes

Sun

Kissler

Kanjilal

et al. 2020

Preprint

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Understanding how antibiotic use drives resistance is crucial for guiding effective strategies to limit the spread of resistance, but the variation in the use-resistance relationship across pathogens and antibiotics remains unclear. Here, we applied sinusoidal models to evaluate the seasonal use-resistance relationship across 3 species and 5 antibiotic classes in Boston, Massachusetts. Use of all 5 classes and resistance in 10 of 15 species-antibiotic combinations showed significant amplitudes of seasonality. However, while seasonal peaks in use varied by class, resistance in all 10 species-antibiotic combinations peaked in the winter and spring. The correlations between seasonal use and resistance thus varied widely, with resistance to all antibiotic classes being most positively correlated with use of the winter-peaking classes (penicillins and macrolides). These findings suggest that in some cases the simple model of use selecting for resistance is inadequate and stewardship strategies will not be equally effective across all species and antibiotics.

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“…In addition, we showed that when ACA was prescribed, dosage in case of renal impairment was often not adjusted, while the dosage should be adjusted in case of an estimated glomerular filtration rate below 30 ml/min. Previous reports have shown that restricting ACA use effectively reduces ACA resistance [31,34]. In Croatia, this restriction has led to a decrease of E.coli resistance from 37 to 11% [34].…”

Section: Discussionmentioning

confidence: 98%

“…Amoxicillin-clavulanic acid (ACA) has become the most frequently used antimicrobial agent globally [12,[28][29][30]. The high use of ACA has been directly linked to an increased antimicrobial resistance, of which the resistance of Klebsiella pneumoniae and Escherichia coli to ACA has become a significant and clinically relevant problem [12,31]. Our findings showed that ACA not only was the most frequently prescribed antimicrobial agent in hospital outpatient clinics, but also the most often inappropriately prescribed, which was also reported in previously performed PPS on hospital wards [32,33].…”

Section: Discussionmentioning

confidence: 99%

The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands

Broek

Hest

Lettinga

et al. 2020

Antimicrob Resist Infect Control

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Objectives: Antimicrobial Stewardship Programs commonly have an in-hospital focus. Little is known about the quality of antimicrobial use in hospital outpatient clinics. We investigated the extent and appropriateness of antimicrobial prescriptions in the outpatient clinics of three hospitals. Methods: From June 2018 to January 2019, we performed ten point prevalence surveys in outpatient clinics of one university hospital and two large teaching hospitals. All prophylactic and therapeutic prescriptions were retrieved from the electronic medical records. Appropriateness was defined as being in accordance with guidelines. Furthermore, we investigated the extent to which the dose was adjusted to renal function and documentation of an antibiotic plan in the case notes. Results: We retrieved 720 prescriptions for antimicrobial drugs, of which 173 prescriptions (24%) were prophylactic. A guideline was present for 95% of prescriptions, of which the guideline non-adherence rate was 25.6% (n = 42/164) for prophylaxis and 43.1% (n = 224/520) for therapy. Of all inappropriate prescriptions (n = 266), inappropriate prescriptions for skin and soft tissue infections (n = 60/226) and amoxicillin-clavulanic acid (n = 67/266) made up the largest proportion. In only 13 of 138 patients with impaired or unknown renal function the dosage regimen was adjusted. Amoxicillin-clavulanic acid was the drug for which most often renal function was not taken into account. In 94.6% of prescriptions the antibiotic plan was documented. Conclusions: In hospital outpatient clinics, a substantial part of therapeutics were inappropriately prescribed. Amoxicillin-clavulanic acid was the most inappropriately prescribed drug, due to non-adherence to the guidelines and because dose adjustment to renal function was often not considered.

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Seasonal variation in antimicrobial resistance rates of community-acquired Escherichia coli bloodstream isolates

Cited by 21 publications

References 35 publications

Temporal trends in ambulatory antibiotic prescription rates in South Carolina: Impact of age, gender, and resident location

Temporal trends in ambulatory antibiotic prescription rates in South Carolina: Impact of age, gender, and resident location

Large variation in the association between seasonal antibiotic use and resistance across multiple bacterial species and antibiotic classes

The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands

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