Systematic analysis of the relationship between antibiotic use and extended-spectrum beta-lactamase resistance in Enterobacteriaceae in a French hospital: a time series analysis

Abstract

The influence of hospital use of antibiotics other than cephalosporins and fluoroquinolones on extended-spectrum beta-lactamase (ESBL) resistance among Enterobacteriaceae is poorly known. Our objective was to explore the association between ESBL and hospital use of various classes of antibacterial agents. The relationship between monthly use of 19 classes of antibacterial agents and incidence of nosocomial ESBL-producing Enterobacteriaceae in a French hospital was studied between 2007 and 2013. Five antibiotic classes were significantly and independently associated with ESBL resistance. Uses of tetracyclines (link estimate ± SE, 0.0066 ± 0.0033), lincosamides (0.0093 ± 0.0029), and other antibacterial agents (0.0050 ± 0.0023) were associated with an increased incidence, while nitrofurantoin (-0.0188 ± 0.0062) and ticarcillin and piperacillin with or without enzyme inhibitor (-0.0078 ± 0.0031) were associated with a decreased incidence. In a multivariate model including 3rd- and 4th-generation cephalosporins, fluoroquinolones, amoxicillin, and amoxicillin-clavulanate, 3rd- and 4th-generation cephalosporins (0.0019 ± 0.0009) and fluoroquinolones (0.0020 ± 0.0008) were associated with an increased ESBL resistance, whereas amoxicillin and amoxicillin-clavulanate were not. Hospital use of tetracyclines and lincosamides may promote ESBL resistance in Enterobacteriaceae. Nitrofurantoin and ticarcillin and piperacillin with or without enzyme inhibitor should be considered as potential alternatives to broad-spectrum cephalosporins and fluoroquinolones to control the diffusion of ESBL resistance.

Systematic review of time lag between antibiotic use and rise of resistant pathogens among hospitalized adults in Europe

“…Ecological studies were reported as retrospective ( n = 19); prospective ( n = 1) and unclear ( n = 8) in terms of study design. Studies were conducted in Germany, 21 , 22 , 25 , 32 , 37 France, 18 , 20 , 28 , 36 , 38 Scotland, 24 , 29 , 30 England, 39 Northern Ireland, 12 , 13 Romania, 15 , 19 Switzerland, 34 , 35 Greece, 23 Hungary, 33 Norway, 14 Slovenia, 16 Spain 27 and Serbia, 31 while a further study included data from four countries in Europe. 26 Where reported, capacity ranged from 11 bed to 3500 bed hospital settings.…”

“…Measures included limiting use of antibiotics, 24 , 31 , 39 the use of alcohol hand rub, 13 , 21 , 22 , 24–26 , 29 compliance audits, 21 , 22 , 26 , 29 and screening of patients with resistant pathogens. 13 , 21 , 24 , 26 , 29 , 30 , 35 , 36 , 26 , 32 Practices varied in a single study 26 that included data from five study sites in France, Hungary, Spain and Northern Ireland. Thirteen ecological studies 12 , 14–20 , 27 , 28 , 33 , 37 , 38 did not explicitly present information about measures to control AMR.…”

“…Thirteen ecological studies 12 , 14–20 , 27 , 28 , 33 , 37 , 38 did not explicitly present information about measures to control AMR. In terms of changes in infection control or ABS practices during the study period, no information was presented in six studies, 14 , 38 , 18 , 20 , 37 whereas nine studies 15–17 , 26 , 30 , 31 , 25 , 33 , 36 reported no change in infection control practices, with one study 25 stating, further, no change in ABS staff during the study period. Remaining studies reported restricting use of fluoroquinolones 12 and carbapenems 25 , 39 and regular or intensified use of alcohol wipes or hand rub 13 , 21 , 22 ( File S6 ).…”

Outpatient Antibiotic Prescription

“…The potentially adverse consequences of increased prescriptions of cephalosporins rather than oral penicillin and amoxicillin are sufficiently demonstrated for the outpatient sector in our view, especially with regard to antibiotic-associated Clostridium difficile infections (24)(25)(26)(27). Data for selection of gram-negative bacteria that are extended-spectrum beta-lactamase (ESBL)-positive or otherwise resistent to cephalosporins are less certain but still plausible (28)(29)(30)(31).…”

The next generation of rapid point-of-care testing identification tools for ventilator-associated pneumonia

“…However, broadspectrum antibiotic treatment must be used with caution, as the evidence for a direct association between antibiotics consumption and the emergence of multi-drug-resistant organisms (MDROs) cannot be neglected (12,13). Infections related to these bacteria are associated with high rate of inappropriate antibiotic treatment and worse outcomes (14).…”