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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Colonization with multiresistant bacteria in acute hospital care: the association of prior antibiotic consumption as
Nasra Dualleh1, Iman Chanchiri1, Helene Skjøt-Arkil2,3
1Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
Background:
Antibiotic resistance poses a worldwide threat and knowledge concerning risk factors for colonization with multiresistant bacteria (MRB) is limited.
Objectives:
To examine the impact of prior antibiotic consumption on MRB colonization, with focus on type of antibiotic and timeline between antibiotic prescription and MRB colonization.
Methods:
A nationwide case-control study was conducted and adults visiting emergency departments were invited to participate. All patients were swabbed in the throat, nose and rectum, and analysed for colonization with ESBL-producing Enterobacteriaceae (ESBL-E), MRSA, carbapenemase-producing enterobacteria and VRE. Antibiotic history 2 years prior to enrolment was collected at an individual level through a national register. Multivariate analyses were performed to examine the association between antibiotic consumption and MRB status. A subgroup analysis of ESBL-E-colonized cases was made.
Results:
We included 256 patients colonized with MRB and 4763 controls. In the 2 years prior to study inclusion, 77% of cases and 68% of controls had at least one antibiotic prescription (P = 0.002). We found a significant increase in risk of colonization with ESBL-E if penicillins (OR = 1.58-1.65) or fluoroquinolones (OR = 2.25-6.15) were prescribed. The analysis of all MRB-colonized patients showed similar results. An assessment of the timeline showed a significant increase in risk of colonization up to 2 years after exposure to penicillins, fluoroquinolones and macrolides.
Conclusions:
The prevalence of ESBL-E colonization was related to fluoroquinolone, macrolide and penicillin consumption for at least 2 years after antibiotic treatment.
Insights
Prior antibiotic use, including penicillins and fluoroquinolones, increases the risk of multiresistant bacteria (MRB) colonization for up to two years. This highlights the long-term impact of antibiotic consumption on MRB carriage.
Area of Science:
- * Infectious Diseases
- * Microbiology
- * Public Health
Background:
- * Antibiotic resistance is a critical global health challenge.
- * Understanding risk factors for multiresistant bacteria (MRB) colonization is crucial but limited.
- * Prior antibiotic consumption is a potential risk factor for MRB colonization.
Purpose of the Study:
- * To investigate the association between previous antibiotic use and MRB colonization.
- * To analyze the impact of specific antibiotic types and the timing of exposure on MRB colonization risk.
Main Methods:
- * Nationwide case-control study involving adults visiting emergency departments.
- * Swabs collected from throat, nose, and rectum to detect ESBL-producing Enterobacteriaceae (ESBL-E), MRSA, carbapenemase-producing enterobacteria, and VRE.
- * Antibiotic history analyzed for two years prior to enrollment using national registers; multivariate analyses performed.
Main Results:
- * 77% of MRB-colonized patients and 68% of controls had prior antibiotic prescriptions (P=0.002).
- * Prescription of penicillins or fluoroquinolones significantly increased ESBL-E colonization risk.
- * Increased colonization risk observed up to two years post-exposure to penicillins, fluoroquinolones, and macrolides.
Conclusions:
- * Consumption of fluoroquinolones, macrolides, and penicillins is linked to ESBL-E colonization.
- * The risk of MRB colonization persists for at least two years after antibiotic treatment.
- * Findings underscore the long-term implications of antibiotic prescribing practices on resistance development.
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