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Influence of primary care antibiotic prescribing on incidence rates of multidrug-resistant Gram-negative bacteria in hospitalised patients

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Abstract

Purpose

Use of antibiotics can give rise to the selection of resistant bacteria. It remains unclear whether antibiotic use in primary care can influence bacterial resistance incidence in patients when hospitalised. The aim of this study is to explore the impact of prior community antibiotic usage on hospital-detected multidrug-resistant Gram-negative (MRGN) incidence rate.

Methods

This pharmacoepidemiological study was case–control in design, and was carried out in the Antrim Area Hospital (N. Ireland) in two phases. In phase 1, the controls were matched according to: age, gender, admission ward, date of admission, and age-adjusted Charlson co-morbidity index score. During the second phase, controls were selected randomly from the total population of admissions to the hospital over the 2-year study period.

Results

In phase 1, multivariate analysis revealed that prior exposure to the second- and third-generation cephalosporins (p = 0.004) and fluoroquinolones (p = 0.023) in primary care was associated with an increased likelihood of MRGN detection in inpatients. In phase 2, an independent relationship between an increased risk of identification of MRGN, while hospitalised was associated with: prolonged hospitalisation (p < 0.001), being elderly (p < 0.001), being female (p = 0.007), and having genitourinary disease (p < 0.001).

Conclusion

This study provides clear evidence which supports the need to optimise antibiotic use in primary care to help reduce MRGN incidence in hospitalised patients.

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Acknowledgements

The authors would like to acknowledge the help provided by the staff of the Honest Broker Service (HBS) within the Business Services Organisation Northern Ireland (BSO). The HBS is funded by the BSO and the Department of Health, Social Services and Public Safety for Northern Ireland (DHSSPSNI). The authors alone are responsible for the interpretation of the data and any views or opinions presented are solely those of the authors and do not necessarily represent those of the BSO.

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Clinical and Practice Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, BT9 7BL, Northern Ireland, UK

    Munther S. Alnajjar & James C. McElnay

  2. Department of Clinical Pharmacy, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates

    Munther S. Alnajjar

  3. School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, UK

    Mamoon A. Aldeyab

  4. Medicines Optimisation Innovation Centre, Trust Headquarters Brettan Hall, Antrim Area Hospital, Antrim, BT41 2RL, Northern Ireland, UK

    Michael G. Scott, Glenda Fleming & Fiona Glimore

  5. Area Microbiology Laboratory, Antrim Area Hospital, Antrim, BT41 2RL, UK

    Mary P. Kearney & David Farren

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  1. Munther S. Alnajjar
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  3. Michael G. Scott
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Corresponding author

Correspondence to James C. McElnay.

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Conflict of interest

The authors declare no conflicts of interest with respect to authorship and/or publication of this article.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For the purposes of conducting this study, governance approvals were obtained from: the Office for Research Ethics Committees Northern Ireland [ORECNI; reference: 14/NI/0065], the Governance Research Office in the Northern Health and Social Care Trust [reference: NRP14-0417-04], and the Honest Broker Governance Board [reference: 002/14]. For this type of study (retrospective in design), formal individual patient consent was not required.

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Alnajjar, M.S., Aldeyab, M.A., Scott, M.G. et al. Influence of primary care antibiotic prescribing on incidence rates of multidrug-resistant Gram-negative bacteria in hospitalised patients. Infection 47, 781–791 (2019). https://doi.org/10.1007/s15010-019-01305-6

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  • DOI: https://doi.org/10.1007/s15010-019-01305-6

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