The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings

M.A. Aldeyab, S. Harbarth, N. Vernaz, M.P. Kearney, M.G. Scott, F.W. Darwish Elhajji, M.A. Aldiab, J.C. Mcelnay

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70 Citations (Scopus)


Aims: The objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates. METHODS: The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009). Results: Analysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P= 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P= 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P= 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P <0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P= 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P <0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates. Discussion: This study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.
Original languageEnglish
Pages (from-to)171-179
Number of pages9
JournalBritish Journal of Clinical Pharmacology
Issue number1
Early online date9 Dec 2011
Publication statusE-pub ahead of print - 9 Dec 2011


  • Antibiotic stewardship
  • ESBL
  • Fluoroquinolones restriction policy
  • Time series analysis
  • aminoglycoside
  • amoxicillin plus clavulanic acid
  • carbapenem
  • cephalosporin
  • ciprofloxacin
  • glycopeptide
  • imidazole derivative
  • lincosamide
  • macrolide
  • nitrofuran
  • penicillin G
  • quinoline derived antiinfective agent
  • sulfonamide
  • tetracycline
  • trimethoprim
  • antibiotic resistance
  • antibiotic sensitivity
  • antibiotic therapy
  • article
  • comorbidity
  • drug use
  • extended spectrum beta lactamase producing Enterobacteriaceae
  • health care policy
  • hospital patient
  • human
  • incidence
  • primary health care
  • priority journal
  • retrospective study
  • Amoxicillin-Potassium Clavulanate Combination
  • Anti-Bacterial Agents
  • Bacteria
  • beta-Lactam Resistance
  • beta-Lactamases
  • Cross Infection
  • Disinfectants
  • Fluoroquinolones
  • Hospitals
  • Humans
  • Incidence
  • Multivariate Analysis
  • Primary Health Care
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors


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