Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: An ecological analysis
Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: An ecological analysis
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DOI：
10.1371/journal.pone.0218134
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发表时间：
2019-06-10
期刊：
影响因子：
3.7
通讯作者：
Robotham, Julie V.
中科院分区：
文献类型：
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作者：
Pouwels, Koen B.;Muller-Pebody, Berit;Robotham, Julie V.
背景大多数将抗生素使用与耐药性联系起来的研究集中在对特定抗生素的耐药性与该特定抗生素的使用之间的简单关联上。然而，抗生素使用与耐药性之间的关系更为复杂。在这里，我们评估选择和共同选择，通过评估哪些抗生素，包括那些主要规定的呼吸道感染，与增加耐药性大肠杆菌之间分离的各种抗生素从urinarysamples.MethodsMonthly初级保健处方的数据，从国家卫生服务（NHS）数字。阳性大肠2014年4月至2016年1月期间英国初级保健（n = 888，207）尿液样本的大肠杆菌记录来自第二代监测系统。弹性网络正则化被用来评估不同抗生素组的处方与临床调试组（CCG）水平上对阿莫西林、头孢氨苄、环丙沙星、复方阿莫西林和呋喃妥因的耐药性之间的关联。英格兰被分为209 CCG，每个NHS的做法延长到一个CCG.ResultsAmoxicillin处方（DDD/1000居民/天测量）与阿莫西林（RR 1.03，95%CI 1.01-1.04）和环丙沙星（RR 1.09，95%CI 1.04-1.17）电阻呈正相关。相比之下，呋喃妥因处方与阿莫西林耐药水平较低相关（RR 0.92，95% CI 0.84-0.97）。结论阿莫西林主要用于治疗呼吸道感染，但并不一定用于治疗呼吸道感染。大肠杆菌引起尿路感染。我们的研究结果表明，在预测干预措施对抗生素耐药性的潜在影响时，重要的是要考虑其他抗生素的使用，包括通常用于其他适应症的抗生素。
BackgroundThe majority of studies that link antibiotic usage and resistance focus on simple associations between the resistance against a specific antibiotic and the use of that specific antibiotic. However, the relationship between antibiotic use and resistance is more complex. Here we evaluate selection and co-selection by assessing which antibiotics, including those mainly prescribed for respiratory tract infections, are associated with increased resistance to various antibiotics among Escherichia coli isolated from urinary samples.MethodsMonthly primary care prescribing data were obtained from National Health Service (NHS) Digital. Positive E. coli records from urine samples in English primary care (n = 888,207) between April 2014 and January 2016 were obtained from the Second Generation Surveillance System. Elastic net regularization was used to evaluate associations between prescribing of different antibiotic groups and resistance against amoxicillin, cephalexin, ciprofloxacin, co-amoxiclav and nitrofurantoin at the clinical commissioning group (CCG) level. England is divided into 209 CCGs, with each NHS practice prolonging to one CCG.ResultsAmoxicillin prescribing (measured in DDD/1000 inhabitants /day) was positively associated with amoxicillin (RR 1.03, 95% CI 1.01-1.04) and ciprofloxacin (RR 1.09, 95% CI 1.04-1.17) resistance. In contrast, nitrofurantoin prescribing was associated with lower levels of resistance to amoxicillin (RR 0.92, 95% CI 0.84-0.97). CCGs with higher levels of trimethoprim prescribing also had higher levels of ciprofloxacin resistance (RR 1.34, 95% CI 1.10-1.59).ConclusionAmoxicillin, which is mainly (and often unnecessarily) prescribed for respiratory tract infections is associated with increased resistance against various antibiotics among E. coli causing urinary tract infections. Our findings suggest that when predicting the potential impact of interventions on antibiotic resistances it is important to account for use of other antibiotics, including those typically used for other indications.