Antimicrobial resistance associations with national primary care antibiotic stewardship policy: Primary care-based, multilevel analytic study
Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown. To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary...
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| description | Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown.
To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections.
Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality.
In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance.
This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality. |
| doi_str_mv | 10.1371/journal.pone.0232903 |
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To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections.
Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality.
In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance.
This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0232903</identifier><identifier>PMID: 32407346</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Amoxicillin ; Antibacterial agents ; Antibiotic resistance ; Antibiotics ; Antimicrobial agents ; Antimicrobial resistance ; Biology and Life Sciences ; Ciprofloxacin ; Classification ; Clinical trials ; Deprivation ; Dispensing ; Distribution ; Drug dispensing ; Drug resistance ; E coli ; Escherichia coli ; Escherichia coli infections ; Family medicine ; Health care ; Infections ; Laboratories ; Laws, regulations and rules ; Medical care quality ; Medicine and Health Sciences ; Microbial drug resistance ; Nitrofurantoin ; Patients ; Penicillins ; People and places ; Prevention ; Primary care ; Primary health care ; Public health ; Regression analysis ; Research and Analysis Methods ; Retirement benefits ; Rural areas ; Statistics ; Studies ; Trimethoprim ; Urine</subject><ispartof>PloS one, 2020-05, Vol.15 (5), p.e0232903-e0232903</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Hammond et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Hammond et al 2020 Hammond et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-8971439260bdf29e92b5f74599703f4a75fc46920695ebdca9084fff4c77c4c63</citedby><cites>FETCH-LOGICAL-c585t-8971439260bdf29e92b5f74599703f4a75fc46920695ebdca9084fff4c77c4c63</cites><orcidid>0000-0002-6657-1514</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224529/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224529/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32407346$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hammond, Ashley</creatorcontrib><creatorcontrib>Stuijfzand, Bobby</creatorcontrib><creatorcontrib>Avison, Matthew B</creatorcontrib><creatorcontrib>Hay, Alastair D</creatorcontrib><title>Antimicrobial resistance associations with national primary care antibiotic stewardship policy: Primary care-based, multilevel analytic study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown.
To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections.
Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality.
In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance.
This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.</description><subject>Amoxicillin</subject><subject>Antibacterial agents</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Biology and Life Sciences</subject><subject>Ciprofloxacin</subject><subject>Classification</subject><subject>Clinical trials</subject><subject>Deprivation</subject><subject>Dispensing</subject><subject>Distribution</subject><subject>Drug dispensing</subject><subject>Drug resistance</subject><subject>E coli</subject><subject>Escherichia coli</subject><subject>Escherichia coli infections</subject><subject>Family medicine</subject><subject>Health care</subject><subject>Infections</subject><subject>Laboratories</subject><subject>Laws, regulations and rules</subject><subject>Medical care quality</subject><subject>Medicine and Health Sciences</subject><subject>Microbial drug 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D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antimicrobial resistance associations with national primary care antibiotic stewardship policy: Primary care-based, multilevel analytic study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-05-14</date><risdate>2020</risdate><volume>15</volume><issue>5</issue><spage>e0232903</spage><epage>e0232903</epage><pages>e0232903-e0232903</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown.
To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections.
Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality.
In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance.
This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32407346</pmid><doi>10.1371/journal.pone.0232903</doi><orcidid>https://orcid.org/0000-0002-6657-1514</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Amoxicillin Antibacterial agents Antibiotic resistance Antibiotics Antimicrobial agents Antimicrobial resistance Biology and Life Sciences Ciprofloxacin Classification Clinical trials Deprivation Dispensing Distribution Drug dispensing Drug resistance E coli Escherichia coli Escherichia coli infections Family medicine Health care Infections Laboratories Laws, regulations and rules Medical care quality Medicine and Health Sciences Microbial drug resistance Nitrofurantoin Patients Penicillins People and places Prevention Primary care Primary health care Public health Regression analysis Research and Analysis Methods Retirement benefits Rural areas Statistics Studies Trimethoprim Urine |
| title | Antimicrobial resistance associations with national primary care antibiotic stewardship policy: Primary care-based, multilevel analytic study |
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