Estimating the impact of cefuroxime versus cefazolin and amoxicillin/clavulanate use on future collateral resistance: a retrospective comparison.
J Antimicrob Chemother
; 77(7): 1992-1995, 2022 06 29.
Article
in En
| MEDLINE
| ID: mdl-35425954
ABSTRACT
BACKGROUND:
Quantitative estimates of collateral resistance induced by antibiotic use are scarce.OBJECTIVES:
To estimate the effects of treatment with amoxicillin/clavulanate or cefazolin, compared with cefuroxime, on future resistance to ceftazidime among hospitalized patients.METHODS:
A retrospective analysis of patients with positive bacterial cultures hospitalized in an Israeli hospital during 2016-19 was conducted. Patients were restricted to those treated with amoxicillin/clavulanate, cefazolin or cefuroxime and re-hospitalized with a positive bacterial culture during the following year. Matching was performed using exact, Mahalanobis and propensity score matching. Each patient in the amoxicillin/clavulanate and cefazolin groups was matched to a single patient from the cefuroxime group, yielding 185185 and 298298 matched patients. Logistic regression and the g-formula (standardization) were used to estimate the OR, risk difference (RD) and number needed to harm (NNH).RESULTS:
Cefuroxime induced significantly higher resistance to ceftazidime than amoxicillin/clavulanate or cefazolin; the marginal OR was 1.76 (95% CIâ=â1.16-2.83) compared with amoxicillin/clavulanate and 1.98 (95% CIâ=â1.41-2.8) compared with cefazolin and the RD was 0.118 (95% CIâ=â0.031-0.215) compared with amoxicillin/clavulanate and 0.131 (95% CIâ=â0.058-0.197) compared with cefazolin. We also estimated the NNH; replacing amoxicillin/clavulanate or cefazolin with cefuroxime would yield ceftazidime resistance in 1 more patient for every 8.5 (95% CIâ=â4.66-32.14) or 7.6 (95% CIâ=â5.1-17.3) patients re-hospitalized in the following year, respectively.CONCLUSIONS:
Our results indicate that treatment with amoxicillin/clavulanate or cefazolin is preferable to cefuroxime, in terms of future collateral resistance. The results presented here are a first step towards quantitative estimations of the ecological damage caused by different antibiotics.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cefazolin
/
Cefuroxime
Type of study:
Observational_studies
Limits:
Humans
Language:
En
Journal:
J Antimicrob Chemother
Year:
2022
Document type:
Article
Affiliation country: