Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli
- PMID: 11588690
- DOI: 10.1086/322677
Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli
Abstract
To evaluate the potential bias of analyzing aggregated data, we separately examined antibiotic exposure and resistance data for 35,423 patients admitted to a university hospital in Utah, from both an individual-patient perspective and group-level perspective. From 1994 through 1998, use of defined daily doses (per 1000 patient-days) of fluoroquinolones, third-generation cephalosporins, ampicillin-sulbactam, and imipenem increased by 82%, 38%, and 99%, and decreased by 38%, respectively, whereas group-level resistance rates of Enterobacteriaceae or Pseudomonas species changed only minimally. However, in individual-patient-level analyses performed by multivariable proportional hazards regression, exposure to a fluoroquinolone, third-generation cephalosporin, ampicillin-sulbactam, or imipenem was a strong risk factor for resistance to fluoroquinolones (adjusted hazard ratio [AHR], 4.0; P<.001), third-generation cephalosporins (AHR, 3.5; P<.001), ampicillin-sulbactam (AHR, 2.3; P=.008), or imipenem (AHR, 5.7; P<.001), respectively. Thus, group-level and individual-patient-level analyses of antibiotic-use-versus-susceptibility relations yielded divergent results. Multicenter studies should include individual-patient-level data to elucidate more fully the relation between antibiotic exposure and resistance.
Similar articles
-
[Continuous surveillance of antimicrobial resistance among nosocomial gram-negative bacilli from intensive care units in China].Zhonghua Yi Xue Za Zhi. 2003 Mar 10;83(5):375-81. Zhonghua Yi Xue Za Zhi. 2003. PMID: 12820912 Chinese.
-
Comparison of beta-lactam regimens for the treatment of gram-negative pulmonary infections in the intensive care unit based on pharmacokinetics/pharmacodynamics.J Antimicrob Chemother. 2005 Nov;56(5):893-8. doi: 10.1093/jac/dki335. Epub 2005 Sep 14. J Antimicrob Chemother. 2005. PMID: 16162664
-
In vitro activity of cefoperazone-sulbactam: Singapore experience.Southeast Asian J Trop Med Public Health. 1996 Dec;27(4):734-7. Southeast Asian J Trop Med Public Health. 1996. PMID: 9253876
-
Colonization with antibiotic-resistant Gram-negative bacilli in the neonatal intensive care unit.Minerva Pediatr. 2003 Oct;55(5):385-93. Minerva Pediatr. 2003. PMID: 14608262 Review.
-
Sulbactam-containing beta-lactamase inhibitor combinations.Clin Microbiol Infect. 2008 Jan;14 Suppl 1:185-8. doi: 10.1111/j.1469-0691.2007.01847.x. Clin Microbiol Infect. 2008. PMID: 18154545 Review.
Cited by
-
Epidemiological interpretation of studies examining the effect of antibiotic usage on resistance.Clin Microbiol Rev. 2013 Apr;26(2):289-307. doi: 10.1128/CMR.00001-13. Clin Microbiol Rev. 2013. PMID: 23554418 Free PMC article. Review.
-
Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases.Infection. 2016 Jun;44(3):395-439. doi: 10.1007/s15010-016-0885-z. Infection. 2016. PMID: 27066980 Free PMC article.
-
Nationwide surveillance of antimicrobial consumption and resistance to Pseudomonas aeruginosa isolates at 203 Japanese hospitals in 2010.Infection. 2013 Apr;41(2):415-23. doi: 10.1007/s15010-013-0440-0. Epub 2013 Mar 8. Infection. 2013. PMID: 23471823
-
Fluoroquinolone use and fluoroquinolone-resistant Pseudomonas aeruginosa is declining in US academic medical centre hospitals.J Antimicrob Chemother. 2012 Jun;67(6):1562-4. doi: 10.1093/jac/dks083. Epub 2012 Mar 13. J Antimicrob Chemother. 2012. PMID: 22416053 Free PMC article. No abstract available.
-
Lessons Learned from Surveillance of Antimicrobial Susceptibilities of Pseudomonas aeruginosa at a Large Academic Medical Center.Pharmaceuticals (Basel). 2010 Apr 1;3(4):1070-1083. doi: 10.3390/ph3041070. Pharmaceuticals (Basel). 2010. PMID: 27713288 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical