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Impact of Different Methods for Describing the Extent of Prior Antibiotic Exposure on the Association Between Antibiotic Use and Antibiotic-Resistant Infection

Published online by Cambridge University Press:  02 January 2015

Emily P. Hyle ,
Warren B. Bilker ,
Leanne B. Gasink  and
Ebbing Lautenbach
Emily P. Hyle
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Warren B. Bilker
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
Leanne B. Gasink
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
Ebbing Lautenbach*
Affiliation:
Center for Research and Education on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104-6021 (elautenb@mail.med.upenn.edu)
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Abstract

Objective.

Many studies have investigated the association between prior antibiotic use and antibiotic resistance. However, methods used in past studies to describe the extent of prior antibiotic use (eg, use of the 2 categories exposure versus no exposure and measurement of duration of exposure) have not been reviewed. The impact of the use of different methods for quantifying the use of antibiotics is unknown. The objectives of this study were to characterize past approaches to describing the extent of antibiotic use and to identify the impact of the use of different methods on associations between use of specific antibiotics and infection with an antibiotic-resistant-organism.

Methods.

We conducted a systematic review of studies that investigated risk factors for extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species to identify variability in past approaches to describing the extent of antibiotic use. We then reanalyzed a data set from a prior study of risk factors for infection with ESBL-producing E. coli and Klebsiella species. We developed 2 separate multivariable models: 1 in which prior antibiotic use was described as a categorical variable (eg, exposure or no exposure) and 1 in which antibiotic use was described as a continuous variable (eg, measured in antibiotic-days). These models were compared qualitatively.

Setting.

Large academic medical center.

Results.

The 25 articles included in the systematic review revealed a variety of methods used to describe the extent of prior antibiotic exposure. Only 1 study justified its approach. Results from the 2 multivariable models that used different methodologic approaches differed substantially. Specifically, use of third-generation cephalosporins was a risk factor for infection with ESBL-producing E. coli and Klebsiella species when antibiotic use was described as a continuous variable but not when antibiotic use was described as a categorical variable.

Conclusions.

There has been no consistent method for assessing the extent of prior antibiotic exposure. The use of different methods may substantially alter the identified antimicrobial risk factors, which has important implications for the resultant interventions regarding antimicrobial use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 647 - 654
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Smolinski, M, Hamburg, M, Lederberg, J. Microbial Threats to Health: Emergence, Detection, and Response. Washington, DC: Institute of Medicine; 2003:32.Google Scholar
2.Livermore, D. Can better prescribing turn the tide of resistance? Nat Rev Microbiol 2004;2:73–78.Google Scholar
3.Harbarth, S, Samore, M. Antimicrobial resistance determinants and future control. Emerg Infect Dis 2005;11:794–801.CrossRefGoogle ScholarPubMed
4.Patterson, J. Antibiotic utilization: is there an effect on antimicrobial resistance? Chest 2001;119:426S–430S.Google Scholar
5.Safdar, N, Maki, D. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.CrossRefGoogle ScholarPubMed
6.Bradford, P. Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933–951.CrossRefGoogle ScholarPubMed
7.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:1162–1171.Google Scholar
8.Sun, GW, Shook, TL, Kay, GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol 1996;49:907–916.Google Scholar
9.Mickey, RM, Greenland, S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–137.Google Scholar
10.Dromigny, J, Nabeth, P, Juergens-Behr, A, Perrier-Gros-Claude, JD. Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal. J Antimicrob Chemother 2005;56:236–239.CrossRefGoogle ScholarPubMed
11.Mendelson, G, Hait, V, Ben-Israel, J, Gronich, D, Granot, E, Raz, R. Prevalence and risk factors of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in an Israeli long-term care facility. Eur J Clin Microbiol Infect Dis 2005;24:17–22.CrossRefGoogle Scholar
12.Qavi, A, Segal-Maurer, A, Mariano, N, et al.Increased mortality associated with a clonal outbreak of ceftazidime-resistant Klebsiella pneumoniae: a case-control study. Infect Control Hosp Epidemiol 2005;26:63–68.Google Scholar
13.Kang, CI, Kim, SH, Kim, DM, et al.Risk factors for and clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2004;25:860–867.Google Scholar
14.Kang, CI, Kim, SH, Park, WB, et al.Clinical outcome of bacteremic spontaneous bacterial peritonitis due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Korean J Intern Med 2004;19:160–164.Google Scholar
15.Lee, SO, Lee, ES, Park, SY, Kim, SY, Seo, YH, Cho, YK. Reduced use of third-generation cephalosporins decreases the acquisition of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2004;25:832–837.CrossRefGoogle ScholarPubMed
16.Panhotra, B, Saxena, A, Al-Ghamdi, A. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae hospital acquired bacteremia: risk factors and clinical outcome. Saudi Med J 2004;25:1871–1876.Google ScholarPubMed
17.Paterson, DL, Ko, WC, Von Gottberg, A, et al.International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial infections. Ann Intern Med 2004;140:26–32.Google Scholar
18.Rodriguez-Bano, J, Navarro, MD, Romero, L, et al.Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol 2004;42:1089–1094.CrossRefGoogle ScholarPubMed
19.Yan, JJ, Ko, WC, Wu, JJ, Tsai, SH, Chuang, CL. Epidemiological investigation of bloodstream infections of extended-spectrum cephalosporin-resistant Escherichia coli in a Taiwanese teaching hospital. J Clin Microbiol 2004;42:3329–3332.Google Scholar
20.Lin, M, Huang, M, Lai, S. Risk factors in the acquisition of extended-spectrum β-lactamase Klebsiella pneumoniae: a case-control study in a district teaching hospital in Taiwan. J Hosp Infect 2003;53:39–45.CrossRefGoogle Scholar
21.Du, B, Long, Y, Lin, H, et al.Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection: risk factors and clinical outcome. Intensive Care Med 2002;28:1718–1723.Google Scholar
22.Ho, PL, Chan, WM, Tsang, KW, Wong, SS, Young, K. Bacteremia caused by Escherichia coli producing extended-spectrum beta-lactamase: a casecontrol study of risk factors and outcomes. Scand J Infect Dis 2002;34:567–573.CrossRefGoogle ScholarPubMed
23.Kim, B, Woo, JH, Kim, MN, et al.Clinical implications of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae bacteraemia. J Hosp Infect 2002;52:99–106.Google Scholar
24.Pena, C, Pujol, M, Ardanuy, C, et al.An outbreak of hospital-acquired Klebsiella pneumoniae bacteraemia, including strains producing extended-spectrum β-lactamase. J Hosp Infect 2001;47:53–59.CrossRefGoogle ScholarPubMed
25.Wiener, J, Quinn, J, Bradford, P. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.CrossRefGoogle ScholarPubMed
26.Schiappa, DA, Hayden, MK, Matushek, MG, et al.Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. J Infect Dis 1996;174:529–536.CrossRefGoogle ScholarPubMed
27.DeChamps, C, Rouby, D, Guelon, D, et al.A case-control study of an outbreak of infections caused by Klebsiella pneumoniae strains producing CTX-1 (TEM-3) beta-lactamase. J Hosp Infect 1991;18:5–13.CrossRefGoogle Scholar
28.Bisson, G, Fishman, NO, Patel, JB, Edelstein, PH, Lautenbach, E. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species: risk factors for colonization and impact of antimicrobial formulary interventions on colonization prevalence. Infect Control Hosp Epidemiol 2002;23:254–260.Google Scholar
29.Pena, C, Ardanuy, C, Ricart, A, et al.Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum β-lactamases. Antimicrob Agents Chemother 1998;42:53–58.CrossRefGoogle ScholarPubMed
30.Piroth, L, Aube, H, Doise, JM, Vincent-Martin, M. Spread of extended-spectrum β-lactamase-producing Klebsiella pneumoniae: are (β-lactamase inhibitors of therapeutic value? Clin Infect Dis 1998;27:76–80.Google Scholar
31.Pena, C, Pujol, M, Ricart, A, et al.Risk factors for faecal carriage of Klebsiella pneumoniae producing extended-spectrum β-lactamase in the intensive care unit. J Hosp Infect 1997;35:9–16.Google Scholar
32.Colodner, R, Rock, W, Chazan, B, Keller, N, Guy, N, Sakran, W. Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis 2004;23:163–167.Google Scholar
33.Lucet, J, Chevret, S, Deere, D, et al.Outbreak of multiply resistant enterobacteriaceae in an intensive care unit: epidemiology and risk factors for acquisition. Clin Infect Dis 1996;22:430–436.Google Scholar
34.Harris, AD, Karchmer, TB, Carmeli, Y, Samore, MH. Methodological principles of case-control studies that analyzed risk factors for antibiotic-resistance: a systematic review. Clin Infect Dis 2001;32:1055–1061.Google Scholar
35.DAgata, EM, Cataldo, MA, Cauda, R, Tacconelli, E. The importance of addressing multidrug resistance and not assuming single-drug resistance in case-control studies. Infect Control Hosp Epidemiol 2006;27:670–674.CrossRefGoogle Scholar
36.Royston, P, Altman, D, Sauerbrei, W. Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med 2006;25:127–141.Google Scholar
37.Dunbar, L, Wunderink, LG, Habib, MP, et al.High-dose, short-course levofloxacin for community-acquired pneumonia: a new treatment paradigm. Clin Infect Dis 2003;37:752–760.Google Scholar