Relationships based on patient-specific data
5.1. Relationships based on patient-specific data
Patient-specific data are used in case control studies in which antecedent antimicrobial use is associated with the development of resistance. In the case control studies, resistant isolates are identified and risk factors are examined. In other prospective studies, the antimicrobials that may increase the risk of colonization with resistant isolates are examined. In these studies, antimicro- bial use may be quantitative (e.g., number of antibiotic courses, grams, number of days of therapy, etc.) or non-quantitative (e.g., binomial data regarding drug exposure of a certain intensity or length of therapy). Since the length of drug exposure prior to development of resistance is not known and whose ascertain- ment may be the purpose of the study, the length of time for the evaluation of antecedent drug use is not standardized.
Numerous studies have evaluated prior antibiotic use and development of resistance. In investigations of the association of antecedent vancomycin use and development of vancomycin-resistant enterococci (VRE), several studies found relationships between vancomycin and development of VRE coloniza- tion or infection (Ena et al., 1993; Frieden et al., 1993; Yates, 1999). In a meta- analysis of 20 studies of vancomycin use and the selection of resistance in
92 Roger L. White enterococci, there was however, no statistically significant relationship. The
author suggested that the design of the individual studies and differences in con- trol group selection, length of hospital stay, and publication bias, likely had a great impact on whether such an association was detected (Carmeli et al., 1999). Exposure to broad-spectrum antimicrobials without activity against enterococci was found to be strongly related to colonization with VRE. In this study, the total number of days of antimicrobial exposure was correlated with the prevalence of VRE (Tokars et al., 1999). Yet others have suggested that antimicrobials with significant activity against anaerobes, rather than vancomycin use, may be important in selection of VRE (Donskey et al., 2000; Yates, 1999).
In a prospective, observational study, Chow et al. (1991) evaluated the emer- gence of resistance during antibiotic therapy in 129 patients with Enterobacter bacteremia. Previous administration of a third generation cephalosporin was more likely than other antimicrobials to be associated with multiresistant Enterobacter isolates in an initial blood culture ( p ⬍ 0.001). Emergence of resistance to a third generation cephalosporin was more frequent than to amino- glycosides ( p ⫽ 0.001) or other -lactam agents ( p ⫽ 0.002). In a 5-year case control study of piperacillin-tazobactam resistant P. aeruginosa, Harris et al. (2002a) found a number of factors and antimicrobials associated with resis- tance. The length of time a patient was at risk for the development of resis- tance, a transfer from one patient-care area to another, ICU stay, and the number of admissions in the previous year were risk factors for the develop- ment of P. aeruginosa resistant to piperacillin-tazobactam. The odds ratio (OR) for several antimicrobials including piperacillin-tazobactam, OR 6.82, imipenem, OR 2.42, broad-spectrum cephalosporins, OR 2.38, aminoglyco- sides, OR 2.18, and vancomycin, OR 1.87 indicated an association with resis- tance. Interestingly, in almost half of the cases of piperacillin-tazobactam resistant P. aeruginosa, the patient did not receive piperacillin-tazobactam. In contrast, in an evaluation of the impact of broad-spectrum antibiotics on detec- tion of resistant isolates, Richard et al. (2001) found that fluoroquinolones were associated with the development of fluoroquinolone-resistant Gram-neg- ative bacilli in gastrointestinal flora. This study illustrate the complexity of relationships between antimicrobial use and resistance and the value in exam- ining patient-specific antecedent antimicrobial use.
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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