Selection and co-selection of antibiotic resistances among Escherichia coli by antibiotic use in primary care: An ecological analysis

AbstractThe 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 which antibiotics, including those mainly prescribed for respiratory tract infections, are associated with increased resistance among Escherichia coli isolated from urinary samples.Monthly 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.Amoxicillin 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).Amoxicillin, 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.Author summaryAntibiotic resistance is increasingly recognised as a threat to modern healthcare. Effective antibiotics are crucial for treatment of serious bacterial infections and are necessary to avoid that complicated surgical procedures and chemotherapy becoming life-threatening. Antibiotic use is one of the main drivers of antibiotic resistance. The majority of antibiotic prescriptions are prescribed in primary care, however, a large proportion of these antibiotic prescriptions are unnecessary. Understanding which antibiotics are causing antibiotic resistance to what extent is needed to prevent under- or over-investment in interventions lowering use of specific antibiotics, such as rapid diagnostic tests for respiratory tract infection.We have statistically evaluated which antibiotics are associated with higher and lower levels of antibiotic resistance against common antibiotics among Escherichia coli bacteria sampled from the urinary tract by comparing antibiotic prescribing and resistance in different geographical areas in England. Our model shows that amoxicillin, the most commonly used antibiotic in England and mainly used for respiratory tract infections, is associated with increased resistance against several other antibiotics among bacteria causing urinary tract infections. The methods used in this study, that overcome several of the limitations of previous studies, can be used to explore the complex relationships between antibiotic use and antibiotic resistance in other settings.

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The selection of optimum fermentation condition for improved expression of sumo-il11 in escherichia coli

TAP CHI SINH HOC ◽

10.15625/0866-7160/v37n1se.6124 ◽

2015 ◽

Vol 37 (1se) ◽

Author(s):

Nguyen Thi Quy ◽

Duong Thu Huong ◽

Dang Thi Ngoc Ha ◽

Le Thi Thu Hong ◽

Do Thi Huyen ◽

...

Keyword(s):

Escherichia Coli ◽

Fermentation Condition ◽

Selection Of

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Implementation of C-reactive protein point of care testing to improve antibiotic targeting in respiratory illness in Vietnamese primary care (ICAT): a study protocol for a cluster randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-040977 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040977

Author(s):

Nga Thi Thuy Do ◽

Rachel Claire Greer ◽

Yoel Lubell ◽

Sabine Dittrich ◽

Maida Vandendorpe ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Prescription ◽

Point Of Care ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Antibiotic Use ◽

Routine Care ◽

C Reactive Protein ◽

Reactive Protein ◽

Randomised Controlled

IntroductionC-reactive protein (CRP), a biomarker of infection, has been used widely in high-income settings to guide antibiotic treatment in patients presenting with respiratory illnesses in primary care. Recent trials in low- and middle-income countries showed that CRP testing could safely reduce antibiotic use in patients with non-severe acute respiratory infections (ARIs) and fever in primary care. The studies, however, were conducted in a research-oriented context, with research staff closely monitoring healthcare behaviour thus potentially influencing healthcare workers’ prescribing practices. For policy-makers to consider wide-scale roll-out, a pragmatic implementation study of the impact of CRP point of care (POC) testing in routine care is needed.Methods and analysisA pragmatic, cluster-randomised controlled trial, with two study arms, consisting of 24 commune health centres (CHC) in the intervention arm (provision of CRP tests with additional healthcare worker guidance) and 24 facilities acting as controls (routine care). Comparison between the treatment arms will be through logistic regression, with the treatment assignment as a fixed effect, and the CHC as a random effect. With 48 clusters, an average of 10 consultations per facility per week will result in approximately 520 over 1 year, and 24 960 in total (12 480 per arm). We will be able to detect a reduction of 12% to 23% or more in immediate antibiotic prescription as a result of the CRP POC intervention. The primary endpoint is the proportion of patient consultations for ARI resulting in immediate antibiotic prescription. Secondary endpoints include the proportion of all patients receiving an antibiotic prescription regardless of ARI diagnosis, frequency of re-consultation, subsequent antibiotic use when antibiotics are not prescribed, referral and hospitalisation.Ethics and disseminationThe study protocol was approved by the Oxford University Tropical Research Ethics Committee (OxTREC, Reference: 53–18), and the ethical committee of the National Hospital for Tropical Diseases in Vietnam (Reference:07/HDDD-NDTW/2019). Results from this study will be disseminated via meetings with stakeholders, conferences and publications in peer-reviewed journals. Authorship and reporting of this work will follow international guidelines.Trial registration detailsNCT03855215; Pre-results.

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Tetracycline-Resistant Bacteria Selected from Water and Zebrafish after Antibiotic Exposure

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063218 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3218

Author(s):

Ana Rita Almeida ◽

Marta Tacão ◽

Joana Soares ◽

Inês Domingues ◽

Isabel Henriques

Keyword(s):

Statistical Significance ◽

Recovery Period ◽

Antibiotic Resistance Genes ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Antibiotic Resistant ◽

Potential Impact ◽

Susceptibility Profiles ◽

Selection Of ◽

Significant Mortality

The emergence of antibiotic-resistant pathogens due to worldwide antibiotic use is raising concern in several settings, including aquaculture. In this work, the selection of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) was evaluated after exposure of zebrafish to oxytetracycline (OTC) for two months, followed by a recovery period. The selection of ARB in water and fish was determined using selective media. The abundance of tetA genes was estimated through qPCR. Higher prevalence of ARB was measured in all samples exposed to the antibiotic when compared to control samples, although statistical significance was only achieved five days after exposure. Isolates recovered from samples exposed to the antibiotic were affiliated with Pseudomonas and Stenotrophomonas. Various antibiotic susceptibility profiles were detected and 37% of the isolates displayed multidrug resistance (MDR). The selection of the tetA gene was confirmed by qPCR at the highest OTC concentration tested. Two MDR isolates, tested using zebrafish embryos, caused significant mortality, indicating a potential impact on fish health and survival. Overall, our work highlights the potential impact of antibiotic contamination in the selection of potential pathogenic ARB and ARGS.

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140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.450 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S200-S200

Author(s):

Michael Hansen ◽

Barbara Trautner ◽

Roger Zoorob ◽

George Germanos ◽

Osvaldo Alquicira ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Departments ◽

Primary Care Clinic ◽

Antibiotic Use ◽

Safety Net ◽

Care Clinic ◽

Primary Care Clinics ◽

Primary Care Patients ◽

Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

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Comparison of Common Enrichment Broths Used in Diagnostic Laboratories for Shiga Toxin—Producing Escherichia coli

Microorganisms ◽

10.3390/microorganisms9030503 ◽

2021 ◽

Vol 9 (3) ◽

pp. 503

Author(s):

Michael Bording-Jorgensen ◽

Hannah Tyrrell ◽

Colin Lloyd ◽

Linda Chui

Keyword(s):

Escherichia Coli ◽

Shiga Toxin ◽

Real Time Pcr ◽

Acute Gastroenteritis ◽

Diagnostic Testing ◽

First Line ◽

Gram Negative ◽

Culture Independent ◽

Surveillance Programs ◽

Selection Of

Acute gastroenteritis caused by Shiga toxin-producing Escherichia coli (STEC) affects more than 4 million individuals in Canada. Diagnostic laboratories are shifting towards culture-independent diagnostic testing; however, recovery of STEC remains an important aspect of surveillance programs. The objective of this study was to compare common broth media used for the enrichment of STEC. Clinical isolates including O157:H7 as well as non-O157 serotypes were cultured in tryptic soy (TSB), MacConkey (Mac), and Gram-negative (GN) broths and growth was compared using culture on sheep’s blood agar and real-time PCR (qPCR). In addition, a selection of the same isolates was spiked into negative stool and enriched in the same three broths, which were then evaluated using culture on CHROMagarTM STEC agar and qPCR. TSB was found to provide the optimal enrichment for growth of isolates with and without stool. The results from this study suggest that diagnostic laboratories may benefit from enriching STEC samples in TSB as a first line enrichment instead of GN or Mac.

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