The time-varying association between previous antibiotic use and antibiotic resistance.
Clin Microbiol Infect
; 29(3): 390.e1-390.e4, 2023 Mar.
Article
em En
| MEDLINE
| ID: mdl-36404422
ABSTRACT
OBJECTIVES:
The objective of the study was to estimate how the time elapsed from previous antibiotic use is associated with antibiotic resistance.METHODS:
Data comprised electronic medical records of all patients in an Israeli hospital who had a positive bacterial culture from 2016 to 2019. These included susceptibility testing results and clinical and demographic data. Mixed-effects time-varying logistic models were fitted to estimate the association between the time elapsed since the last use of aminoglycosides and gentamicin resistance (n = 13 095), cephalosporins and ceftazidime resistance (n = 13 051), and fluoroquinolones and ciprofloxacin resistance (n = 15 364) while adjusting for multiple covariates.RESULTS:
For all examined antibiotics, previous antibiotic use had a statistically significant association with resistance (p < 0.001). These associations exhibited a clear decreasing pattern over time, which we present as a flexible function of time. Nonetheless, previous antibiotic use remained a significant risk factor for resistance for at least 180 days when the adjusted ORs were 1.94 (95% CI, 1.40-2.69), 1.33 (95% CI, 1.10-1.61), and 2.25 (95% CI, 1.49-3.41) for gentamicin, ceftazidime, and ciprofloxacin, respectively.DISCUSSION:
The association between prior antibiotic use and resistance decreases over time. Commonly used cut-offs for prior antibiotic use can either misclassify patients still at higher risk when too recent or provide a diluted estimate of the effects of antibiotic use on future resistance when too distant. Hence, prior antibiotic use should be considered a time-dependent risk factor for resistance in both epidemiological research and clinical practice.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Ceftazidima
/
Antibacterianos
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article