TY - JOUR
T1 - Impact of quinolone restriction on resistance patterns of Escherichia coli isolated from urine by culture in a community setting
AU - Gottesman, Bat Sheva
AU - Carmeli, Yehuda
AU - Shitrit, Pnina
AU - Chowers, Michal
N1 - Funding Information:
Potential conflicts of interest. During the last 3 years, Y.C. personally, his laboratory, and/or studies that he has conducted have received grants, honoraria, travel support, consulting fees, and other forms of financial support from the following companies: Basilea Pharmaceutical, Bioline Therapeutics, Cempra Pharmaceuticals, Intercell Pharmaceuticals, IPSAT, Johnson & Johnson Pharmaceuticals, Merck & Co, Neopharm, Pfizer Pharmaceuticals, Teva Medical, Wyeth Pharmaceuticals, and XTL Pharmaceuticals. All other authors: no conflicts.
PY - 2009/9/15
Y1 - 2009/9/15
N2 - Background. Decreased antimicrobial susceptibility after increased antibiotic use is a known phenomenon. Restoration of susceptibility once antimicrobial use is decreased is not self-evident. Our objective was to evaluate, in a community setting, the impact of quinolone restriction on the antimicrobial resistance of E. coli urine isolates. Methods. We conducted a retrospective, quasi-experimental ecological study to assess the proportion of quinolone-susceptible E. coli urine isolates in the periods before, during, and after a nationwide restriction on ciprofloxacin use was implemented. We used an interrupted time interval analysis for outcome evaluation. Results. We found a significant decline in quinolone consumption, measured as defined daily doses (DDDs) per month, between the preintervention and intervention periods (point estimate, -1827.3 DDDs per month; 95% confidence interval [CI], -2248.8 to -1405.9 DDDs per month; P < .001). This decline resulted in a significant decrease in E. coli nonsusceptibility to quinolones, from a mean of 12% in the preintervention period to a mean of 9% in the intervention period (odds ratio, 1.35; P = .014). The improved susceptibility pattern reversed immediately when quinolone consumption rose. Moreover, a highly significant inverse relationship was found between the level of quinolone use (regardless of intervention period) and the susceptibility of E. coli urine isolates to quinolone (odds ratio, 1.70; 95% CI, 1.26-2.28). During the months of highest quinolone use (8321 DDDs per month), the proportion of nonsusceptibility was 14%, whereas during the months of lowest quinolone use (4027 DDDs per month), the proportion of nonsusceptibility was 9%. An average decrease in resistance of 1.16% was observed for each decrease of 1000 DDDs. Conclusion. Reducing quinolone consumption can lead to an immediate increase in the susceptibility of E. coli urine isolates to quinolones.
AB - Background. Decreased antimicrobial susceptibility after increased antibiotic use is a known phenomenon. Restoration of susceptibility once antimicrobial use is decreased is not self-evident. Our objective was to evaluate, in a community setting, the impact of quinolone restriction on the antimicrobial resistance of E. coli urine isolates. Methods. We conducted a retrospective, quasi-experimental ecological study to assess the proportion of quinolone-susceptible E. coli urine isolates in the periods before, during, and after a nationwide restriction on ciprofloxacin use was implemented. We used an interrupted time interval analysis for outcome evaluation. Results. We found a significant decline in quinolone consumption, measured as defined daily doses (DDDs) per month, between the preintervention and intervention periods (point estimate, -1827.3 DDDs per month; 95% confidence interval [CI], -2248.8 to -1405.9 DDDs per month; P < .001). This decline resulted in a significant decrease in E. coli nonsusceptibility to quinolones, from a mean of 12% in the preintervention period to a mean of 9% in the intervention period (odds ratio, 1.35; P = .014). The improved susceptibility pattern reversed immediately when quinolone consumption rose. Moreover, a highly significant inverse relationship was found between the level of quinolone use (regardless of intervention period) and the susceptibility of E. coli urine isolates to quinolone (odds ratio, 1.70; 95% CI, 1.26-2.28). During the months of highest quinolone use (8321 DDDs per month), the proportion of nonsusceptibility was 14%, whereas during the months of lowest quinolone use (4027 DDDs per month), the proportion of nonsusceptibility was 9%. An average decrease in resistance of 1.16% was observed for each decrease of 1000 DDDs. Conclusion. Reducing quinolone consumption can lead to an immediate increase in the susceptibility of E. coli urine isolates to quinolones.
UR - http://www.scopus.com/inward/record.url?scp=70049084153&partnerID=8YFLogxK
U2 - 10.1086/605530
DO - 10.1086/605530
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C2 - 19686074
AN - SCOPUS:70049084153
SN - 1058-4838
VL - 49
SP - 869
EP - 875
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -