| A multilevel analysis of trimethoprim and ciprofloxacin prescribing and resistance of uropathogenic Escherichia coli in general practice. | |
| | |
MedLine Citation:
|
PMID: 20457673 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Objectives: A retrospective analysis of databases was performed to describe trimethoprim and ciprofloxacin prescribing and resistance in Escherichia coli within general practices in the West of Ireland from 2004 to 2008. METHODS: Antimicrobial susceptibility testing was performed by disc diffusion methods according to the CLSI methods and criteria on significant E. coli isolates (colony count >10(5) cfu/mL) from urine samples submitted from general practice. Data were collected over a 4.5 year period and aggregated at practice level. Data on antimicrobial prescribing of practices were obtained from the national Irish prescribing database, which accounts for approximately 70% of all medicines prescribed in primary care. A multilevel model (MLwiN) was fitted with trimethoprim/ciprofloxacin resistance rates as outcome and practice prescribing as predictor. Practice and individual routinely collected variables were controlled for in the model. RESULTS: Seventy-two general practices sent between 13 and 720 (median 155) samples that turned out to be E. coli positive. Prescribing at practice level was significantly correlated with the probability of antimicrobial-resistant E. coli with an odds ratio of 1.02 [95% confidence interval (CI) 1.01-1.04] for every additional prescription of trimethoprim per 1000 patients per month in the practice and 1.08 (1.04-1.11) for ciprofloxacin. Age was a significant risk factor in both models. Higher variation between practices was found for ciprofloxacin as well as a yearly increase in resistance. Comparing a 'mean' practice with 1 prescription per month with one with 10 prescriptions per month showed an increase in predicted probability of a resistant E. coli for the 'mean' patient from 23.9% to 27.5% for trimethoprim and from 3.0% to 5.5% for ciprofloxacin. CONCLUSIONS: A higher level of antimicrobial prescribing in a practice is associated with a higher probability of a resistant E. coli for the patient. The variation in antimicrobial resistance levels between practices was relatively higher for ciprofloxacin than for trimethoprim. |
| | |
Authors:
|
Akke Vellinga; Andrew W Murphy; Belinda Hanahoe; Kathleen Bennett; Martin Cormican |
Related Documents
:
|
9973753 - A descriptive study of drug therapy and cost for elderly residents in a nursing home. 10818653 - Morbidity, deprivation, and antidepressant prescribing in general practice. 8477613 - Fijian penis marbles: an example of artificial penile nodules. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-05-10 |
Journal Detail:
|
Title: The Journal of antimicrobial chemotherapy Volume: 65 ISSN: 1460-2091 ISO Abbreviation: J. Antimicrob. Chemother. Publication Date: 2010 Jul |
Date Detail:
|
Created Date: 2010-06-10 Completed Date: 2010-09-16 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 7513617 Medline TA: J Antimicrob Chemother Country: England |
Other Details:
|
Languages: eng Pagination: 1514-20 Citation Subset: IM |
Affiliation:
|
Discipline of General Practice, School of Medicine, NUI Galway, Ireland. akke.vellinga@nuigalway.ie |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Aged Aged, 80 and over Anti-Bacterial Agents / therapeutic use Ciprofloxacin / therapeutic use* Drug Prescriptions / statistics & numerical data* Drug Resistance, Bacterial* Family Practice / methods* Female Humans Ireland Male Microbial Sensitivity Tests Middle Aged Multilevel Analysis Retrospective Studies Trimethoprim / therapeutic use* Urinary Tract Infections / microbiology* Uropathogenic Escherichia coli / drug effects*, isolation & purification Young Adult |
| Chemical | |
Reg. No./Substance:
|
0/Anti-Bacterial Agents; 738-70-5/Trimethoprim; 85721-33-1/Ciprofloxacin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Effects of the calpain inhibitor MDL28170 on the clinically relevant forms of Trypanosoma cruzi in v...
Next Document: The relationship of audibility and the development of canonical babbling in young children with hear...