The impact of antibiotic use on the incidence and resistance pattern of extended‐spectrum beta‐lactamase‐producing bacteria in primary and secondary healthcare settings

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• The emergence and spread of bacteria producing extended-spectrum beta-lactamases (ESBLs) has important therapeutic and epidemiologic implications.• A key target for the establishment of hospital antibiotic stewardship is reducing the occurrence of additional antibiotic resistance. • Further research is needed to accumulate supporting evidence that reducing antibiotic use will result in a parallel reduction in antibiotic resistance. WHAT THIS STUDY ADDS• Fluoroquinolone restriction reversed ciprofloxacin resistance in primary and secondary healthcare settings.• Fluoroquinolone restriction reduced ESBL-producing bacteria incidence rates in both the primary and secondary healthcare settings. • This study highlights the value of time-series analysis in designing efficient antibiotic stewardship. AIMSThe objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates. METHODSThe study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009). RESULTSAnalysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P = 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P = 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P = 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P < 0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P = 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P < 0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates. DISCUSSIONThis study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship.

Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

“…This is supported by two studies showing that fluoroquinolone use correlates with increased ESBL-producing coliforms in ICU patients, and another linking quinolone use with ESBL-producing coliforms in hospital and the community. The latter found a 1-month lag effect between quinolone consumption and ESBL-producing coliform rates rather than the 2 months reported here [10][11][12].…”

Ambulantna poraba antibiotikov pri otrocih v Sloveniji

“…Nedavna raziskava je pokazala pozitivno povezavo med rabo AMK v domačem okolju in bolnišnicah in pojavnostjo bakterij, ki izločajo laktamaze beta z razširjenim spektrom (angl. extended-spectrum beta-lactamases, ESBL) (15). Mehanizem odpornosti pnevmokokov proti penicilinskim antibiotikom ni z izločanjem laktamaz beta, zato amoksicilin s klavulansko ki-slino ni primeren pri okužbah z odpornimi pnevmokoki, pač pa višji odmerki penicilina ali amoksicilina.…”

Loop-Mediated Isothermal Amplification untuk Mendeteksi Gen blaTEM Sebagai Penyandi Extended-Spectrum Beta-Lactamase pada Isolat Enterobacteriaceae

“…Setiap harinya kemungkinan untuk terinfeksi bakteri penghasil ESBL sebesar 44,8% pada 1 per seribu pasien yang dirawat di rumah sakit dan sebesar 10% pada 1 per seratus ribu orang di masyarakat. 5 Di Asia pada tahun 1999 diperkirakan bahwa sekitar 12-24% isolat Eschericia coli positif ESBL, sementara untuk Klebsiella pneumoniae penghasil ESBL jumlahnya kurang dari 5%. 6 Persentase serupa ditemukan pada penelitian di RSP Dr. Soetomo Surabaya pada tahun 2010, 7 sementara penelitian di Bandung pada tahun 2012 didapatkan angka yang sangat tinggi, yaitu 72% isolat Klebsiella pneumoniae sampel pasien yang menghasilkan ESBL.…”

“…Primer gen bla TEM yang dipergunakan adalah primer forward 5'-GTATCCGCTCATGGAGACAA-TAACCCTG-3' (28 basa) dan primer reverse 5'-CCAATGCTTAATCAGTGGAGGCACC-3' (25 basa) yang telah dipergunakan pada penelitian sebelumnya 16 dengan reaksi 50 μL, terdiri atas 25 μL DreamTaq Green PCR Master Mix (2X); 0,5 μL primer forward 10 μM dan 0, 5 Reaksi LAMP dengan total volume 25 μL terdiri atas 2,5 μL isothermal amplification buffer 10x; 3,5 μL dNTP Mix 10 mM; 2 μL MgCl 2 50 mM ; 2,5 μL primer F3 2 μM; 2,5 μL primer B3 2 μM; 2,5 μL primer FIP 16 μM; 2,5 μL primer BIP 16 μM; 1 μL Bst 2.0 (8.000 U/mL); 5 μL akuades steril dan 1 μL sampel. Kondisi reaksi LAMP adalah 30 menit pada suhu 65°C yang diakhiri dengan penghentian reaksi pada suhu 80°C selama 2 menit.…”